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Brunetti ND, Curcio A, Nodari S, Parati G, Carugo S, Molinari M, Acquistapace F, Gensini G, Molinari G. The Italian Society of Cardiology and Working Group on Telecardiology and Informatics 2023 updated position paper on telemedicine and artificial intelligence in cardiovascular disease. J Cardiovasc Med (Hagerstown) 2023; 24:e168-e177. [PMID: 37186567 DOI: 10.2459/jcm.0000000000001447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
In 2015, the Italian Society of Cardiology and its Working Group on Telemedicine and Informatics issued a position paper on Telecardiology, resuming the most eminent evidence supporting the use of information and communication technology in principal areas of cardiovascular care, ranked by level of evidence. More than 5 years later and after the global shock inflicted by the SARS-CoV-2 pandemic, an update on the topic is warranted. Recent evidence and studies on principal areas of cardiovascular disease will be therefore reported and discussed, with particular focus on telemedicine for cardiovascular care in the COVID-19 context. Novel perspectives and opportunities disclosed by artificial intelligence and its applications in cardiovascular disease will also be discussed. Finally, modalities by which machine learning have realized remote patient monitoring and long-term care in recent years, mainly filtering critical clinical data requiring selective hospital admission, will be provided.
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Affiliation(s)
- Natale D Brunetti
- Division of Cardiology, Department of Medical & Surgical Sciences, University of Foggia, Foggia
| | - Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, University 'Magna Graecia' of Catanzaro, Catanzaro
| | - Savina Nodari
- Dept. of Medical and Surgical Specialities, Radiological Sciences and Public Health-University of Brescia Medical School
- University of Brescia Medical School, Brescia
| | | | - Stefano Carugo
- Department of Clinical Sciences and Community Health
- Cardiology Unit, Dept. of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore, University of Milan, Milan
| | - Martina Molinari
- Department of Cardiology, Ospedale 'P.A. Micone', ASL 3 Genovese, Genoa, Italy
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Ghilencea LN, Chiru MR, Stolcova M, Spiridon G, Manea LM, Stănescu AMA, Bokhari A, Kilic ID, Secco GG, Foin N, Di Mario C. Telemedicine: Benefits for Cardiovascular Patients in the COVID-19 Era. Front Cardiovasc Med 2022; 9:868635. [PMID: 35935629 PMCID: PMC9347362 DOI: 10.3389/fcvm.2022.868635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/21/2022] [Indexed: 11/26/2022] Open
Abstract
The recent pandemic with SARS-CoV-2 raises questions worldwide regarding telemedicine for housebound patients, including those with cardiovascular conditions. The need for further investigation, monitoring and therapeutic management are advancing practical issues which had not been identified for consideration prior to the pandemic. Using the marketing assessment, we identified the needs of the patients and evaluated the future steps necessary in the short term to meet them. The research found progress made via telemedicine in monitoring and conducting minor decisions (like up-titrating the doses of different medication regimens) in patients with several cardiovascular diseases (heart failure, atrial fibrillation, high blood pressure), as there is a worldwide trend to develop new telemonitoring biosensors and devices based on implantable delivered transcatheter. The worldwide telemedicine trend encourages a switch from small and hesitating steps to a more consistent assessment of the patients, based on high technology and Interventional Cardiology. Cardiovascular telemedicine, although made a sustainable effort in managing patients' health, has many obstacles to overcome before meeting all their needs. Data security, confidentiality and reimbursement are the top priorities in developing remote Cardiology. The regulatory institutions need to play an integrative role in leading the way for defining the framework of future telemedicine activities. The SARS-CoV-2 outbreak with all its tragedy served to reinforce the message that telemedicine services can be life-saving for cardiovascular patients. Once the Covid-19 era will fade away, telemedicine is likely to remain a complementary service of standard care. There is still room to improve the remote identification and investigation of heart disease, provide an accurate diagnosis and therapeutic regimen, and update regulations and guidelines to the new realities of technological progress in the field.
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Affiliation(s)
- Liviu-Nicolae Ghilencea
- Department of Cardiology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- *Correspondence: Liviu-Nicolae Ghilencea
| | | | - Miroslava Stolcova
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Gabriel Spiridon
- Department and European Project Development, Institute of Scientific Research and Technological Development in Automation and Informatics, Bucharest, Romania
| | - Laura-Maria Manea
- Department of Cardiology, Elias University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Awais Bokhari
- Department of Cardiology, Bedford Hospital NHS Foundation Trust, Bedford, United Kingdom
| | - Ismail Dogu Kilic
- Department of Cardiology, Pamukkale University Hospital, Denizli, Turkey
| | - Gioel Gabriel Secco
- Department of Interventional Cardiology and Structural Heart Disease, SS. Antonio e Biagioe Cesare Arrigo Hospital, Alessandria, Italy
| | - Nicolas Foin
- Duke-NUS Medical School, National Heart Research Institute, Singapore, Singapore
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
- Royal Brompton Hospital, NHSFT, London, United Kingdom
- Department of Cardiology, University of Florence, Florence, Italy
- Carlo Di Mario
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Palozzi G, Antonucci G. Mobile-Health based physical activities co-production policies towards cardiovascular diseases prevention: findings from a mixed-method systematic review. BMC Health Serv Res 2022; 22:277. [PMID: 35232456 PMCID: PMC8886562 DOI: 10.1186/s12913-022-07637-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the first cause of death globally, with huge costs worldwide. Most cases of CVD could be prevented by addressing behavioural risk factors. Among these factors, there is physical and amateur sports activity (PASA), which has a linear negative correlation with the risk of CVD. Nevertheless, attempts to encourage PASA, as exercise prescription programmes, achieved little impact at the community-wide level. A new frontier to promote PASA is represented by mobile health tools, such as exergaming, mobile device apps, health wearables, GPS/GIS and virtual reality. Nevertheless, there has not yet been any evident turnabout in patient active involvement towards CVD prevention, and inactivity rates are even increasing. This study aims at framing the state of the art of the literature about the use of m-health in supporting PASA, as a user-centric innovation strategy, to promote co-production health policies aiming at CVD prevention. METHODS A mixed-method systematic literature review was conducted in the fields of health and healthcare management to highlight the intersections between PASA promotion and m-health tools in fostering co-produced services focused on CVD prevention. The literature has been extracted by the PRISMA logic application. The resulting sample has been first statistically described by a bibliometric approach and then further investigated with a conceptual analysis of the most relevant contributions, which have been qualitatively analysed. RESULTS We identified 2,295 studies, on which we ran the bibliometric analysis. After narrowing the research around the co-production field, we found 10 papers relevant for the concept analysis of contents. The interest about the theme has increased in the last two decades, with a high prevalence of contributions from higher income countries and those with higher CVD incidence. The field of research is highly multi-disciplinary; most of documents belong to the medical field, with only a few interconnections with the technology and health policy spheres. Although the involvement of patients is recognized as fundamental for CVD prevention through PASA, co-design schemes are still lacking at the public management level. CONCLUSIONS While the link between the subjects of motor activity, medicine and technology is clear, the involvement of citizens in the service delivery process is still underinvestigated, especially the issue concerning how "value co-creation" could effectively be applied by public agencies. In synthesis, the analysis of the role of co-production as a system coordination method, which is so important in designing and implementing preventive care, is still lacking.
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Affiliation(s)
- Gabriele Palozzi
- Department Management & Law, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Antonucci
- DEA Department, "G. d'Annunzio" University of Chieti-Pescara, Viale Pindaro, 42, Pescara, 65127, Italy.
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Molinari G, Brunetti ND, Nodari S, Molinari M, Spagna G, Ioakim M, Migliore G, Dattoli V, Di Cillo O. Impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease in Italy. Intern Emerg Med 2021; 16:1191-1196. [PMID: 33294959 PMCID: PMC7722980 DOI: 10.1007/s11739-020-02564-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/05/2020] [Indexed: 10/27/2022]
Abstract
The Covid-19 pandemic affected large part of Italy since February 2020; we, therefore, aimed to assess the impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease (CVD) in Italy. We analyzed data from three telemedicine dispatch centers, one located in Genoa, serving private clients (pharmacies, general practitioners), one in Brescia, serving pharmacies, and one in Bari, serving regional public STEMI network and emergency medical service in Apulia (4 million inhabitants). Demographic data and principal electrocardiogram diagnosis were collected and analyzed. Records from the time interval March 1, 2020 and April 1, 2020 were compared with the corresponding period in 2019. The comparative analysis of data shows a 54% reduction of telemedicine electrocardiogram transmission in Genoa telemedicine center (from 364 to 166), 68% in Brescia (from 5.745 to 1.905), 24% in Bari (from 15.825 to 11.716); relative reduction according to electrocardiogram diagnosis was 38% for acute coronary syndrome, 40% for other acute CVD in Genoa center, 24% for acute coronary syndrome, and 38% for other acute CVD in Bari. Male/female ratio remained substantially unchanged. A dramatic reduction of telemedicine access for CVD was observed during Covid-19 outbreak in March 2020 in Italy. The reduction was substantially consistent for all electrocardiogram findings, ACS, other acute CVD and normal.
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Affiliation(s)
| | - Natale Daniele Brunetti
- grid.10796.390000000121049995Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Savina Nodari
- grid.7637.50000000417571846Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Battineni G, Sagaro GG, Chintalapudi N, Amenta F. The Benefits of Telemedicine in Personalized Prevention of Cardiovascular Diseases (CVD): A Systematic Review. J Pers Med 2021; 11:658. [PMID: 34357125 PMCID: PMC8304370 DOI: 10.3390/jpm11070658] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/12/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Adverse effects on personalized care and outcomes of cardiovascular diseases (CVD) could occur if health systems do not work in an efficient manner. The pandemic caused by COVID-19 has opened new perspectives for the execution and advancement of cardiovascular tests through telemedicine platforms. OBJECTIVE This study aimed to analyze the usefulness of telemedical systems for providing personal care in the prevention of CVD. METHODS A systematic review analysis was conducted on the literature available from libraries such as PubMed (Medline), Scopus (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Data available in the last 10 years (2011-2020) were also examined by PRISMA guidelines. The selected studies were divided into two categories: (1) benefits of telemedicine in CVD prevention, and (2) recent progress in telemedical services for personalized care of CVD. RESULTS The literature search produced 587 documents, and 19 articles were considered in this review. Results highlighted that the timely delivery of preventive care for CVD which can be implemented virtually can benefit and modify morbidity and mortality. This could also reduce the pressure on hospitals by decreasing acute CVD occurrence among the general population. The use of these technologies can also help to reduce access to hospitals and other medical devices when not necessary. CONCLUSIONS Telemedicine platforms can be used for regular checkups for CVD and contribute to preventing the occurrence of acute events and more in general the progression of CVD.
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Affiliation(s)
- Gopi Battineni
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (G.G.S.); (N.C.); (F.A.)
| | - Getu Gamo Sagaro
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (G.G.S.); (N.C.); (F.A.)
| | - Nalini Chintalapudi
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (G.G.S.); (N.C.); (F.A.)
| | - Francesco Amenta
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (G.G.S.); (N.C.); (F.A.)
- Research Department, International Radio Medical Centre (C.I.R.M.), 00144 Rome, Italy
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Kamel H, Hafez MS, Bastawy I. Telemedicine Improves the Short-Term Medical Care of Acute ST-Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention. Front Cardiovasc Med 2021; 8:693731. [PMID: 34322529 PMCID: PMC8311002 DOI: 10.3389/fcvm.2021.693731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 06/09/2021] [Indexed: 01/27/2023] Open
Abstract
Objectives: Telemedicine appears to be a promising tool for healthcare professionals to deliver remote care to patients with cardiovascular diseases especially during the COVID-19 pandemic. We aimed in this study to evaluate the value of telemedicine added to the short-term medical care of acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). Methods: Two hundred acute STEMI patients after primary PCI were randomly divided into two groups. One hundred patients in group A (study group) received a monthly videoconferencing teleconsultation using a smartphone application for 3 months starting 1 week after discharge and at least a single face-to-face (F2F) clinic visit. We reviewed in each virtual visit the symptoms of patients, adherence to healthy lifestyle measures, medications, smoking cessation, and cardiac rehabilitation. Group B (control group) included 100 patients who received at least a single F2F clinic visit in the first 3 months after discharge. Both groups were interviewed after 4 months from discharge for major adverse cardiac events (MACE), adherence to medications, smoking cessation, and cardiac rehabilitation. A survey was done to measure the satisfaction of patients with telemedicine. Results: There was no significant difference between both groups in MACE and their adherence to aspirin, P2Y12 inhibitor, and beta-blockers. However, group A patients had better adherence to statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, smoking cessation, and cardiac rehabilitation. Sixty-one percent of patients stated that these videoconferencing teleconsultations were as good as the clinic visits, while 87% of patients were satisfied with telemedicine. Conclusions: Telemedicine may provide additional benefit to the short-term regular care after primary PCI to STEMI patients through videoconferencing teleconsultations by increasing their adherence to medications and healthy lifestyle measures without a significant difference in the short-term MACE. These virtual visits gained a high level of satisfaction among the patients.
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Affiliation(s)
- Heba Kamel
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohamed Saber Hafez
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Islam Bastawy
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Stipa G, Gabbrielli F, Rabbito C, Di Lazzaro V, Amantini A, Grippo A, Carrai R, Pasqui R, Barloscio D, Olivi D, Lori S. The Italian technical/administrative recommendations for telemedicine in clinical neurophysiology. Neurol Sci 2021; 42:1923-1931. [PMID: 32974797 PMCID: PMC7514225 DOI: 10.1007/s10072-020-04732-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022]
Abstract
Recent advances in technology, information technology, Internet networks, and, more recently, fiber optics in industrialized countries allow the exchange of a huge amount of data, in real time, across the globe. The acquisition of increasingly sophisticated technologies has made it possible to develop telemedicine, by which the specialist's evaluation can be carried out on the patient even remotely. In Italy, this very useful tool, although possible from a technological and information technology point of view, has not been developed because of the lack of clear and univocal rules and of major administrative obstacles related to the Italian Public Health System. To promote telemedicine implementation in Italy, the Italian Society of Clinical Neurophysiology and the Italian Society of Telemedicine together with the National Centre for Telemedicine and New Assistive Technologies of the Italian Higher Institute of Health prepared these inter-society recommendations. Because of potential forensic value of these recommendations, they were prepared considering the current regulations and the General Data Protection Regulation and will provide the basis for a Consensus Conference planned to discuss and prepare National Telemedicine Guidelines.
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Affiliation(s)
- G Stipa
- Neurophysiology Unit, Neuroscience Department, Terni Hospital - A.O. S. Maria, Terni, Italy.
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy.
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy.
| | - F Gabbrielli
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
- National Center for Telemedicine, Italian National Institute for Health - ISS, Rome, Italy
| | - C Rabbito
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
| | - V Di Lazzaro
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy
| | - A Amantini
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Neurophysiology Unit, Neuro-Muscular-Skeletal Department, Careggi Hospital, University of Florence, Florence, Italy
| | - A Grippo
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
- Neurophysiology Unit, Neuro-Muscular-Skeletal Department, Careggi Hospital, University of Florence, Florence, Italy
| | - R Carrai
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Neurophysiology Unit, Neuro-Muscular-Skeletal Department, Careggi Hospital, University of Florence, Florence, Italy
| | - R Pasqui
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
| | - D Barloscio
- Neurophysiology Unit, Neuroscience Department, Terni Hospital - A.O. S. Maria, Terni, Italy
| | - D Olivi
- Neurophysiology Unit, Neuroscience Department, Terni Hospital - A.O. S. Maria, Terni, Italy
| | - S Lori
- Italian Society of Clinical Neurophysiology - SINC, Rome, Italy
- Italian Society of Telemedicine and Healthcare - SIT, Rome, Italy
- Neurophysiology Unit, Neuro-Muscular-Skeletal Department, Careggi Hospital, University of Florence, Florence, Italy
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Yuan N, Pevnick JM, Botting PG, Elad Y, Miller SJ, Cheng S, Ebinger JE. Patient Use and Clinical Practice Patterns of Remote Cardiology Clinic Visits in the Era of COVID-19. JAMA Netw Open 2021; 4:e214157. [PMID: 33818619 PMCID: PMC8022216 DOI: 10.1001/jamanetworkopen.2021.4157] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has led to an unprecedented shift in ambulatory cardiovascular care from in-person to remote visits. OBJECTIVE To understand whether the transition to remote visits is associated with disparities in patient use of care, diagnostic test ordering, and medication prescribing. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used electronic health records data for all ambulatory cardiology visits at an urban, multisite health system in Los Angeles County, California, during 2 periods: April 1, 2019, to December 31, 2019 (pre-COVID) and April 1 to December 31, 2020 (COVID-era). Statistical analysis was performed from January to February 2021. EXPOSURE In-person or remote ambulatory cardiology clinic visit at one of 31 during the pre-COVID period or COVID-era period. MAIN OUTCOMES AND MEASURES Comparison of patient characteristics and frequencies of medication ordering and cardiology-specific testing across 4 visit types (pre-COVID in-person (reference), COVID-era in-person, COVID-era video, COVID-era telephone). RESULTS This study analyzed data from 87 182 pre-COVID in-person, 74 498 COVID-era in-person, 4720 COVID-era video, and 10 381 COVID-era telephone visits. Across visits, 79 572 patients were female (45.0%), 127 080 patients were non-Hispanic White (71.9%), and the mean (SD) age was 68.1 (17.0) years. Patients accessing COVID-era remote visits were more likely to be Asian, Black, or Hispanic individuals (24 934 pre-COVID in-person visits [28.6%] vs 19 742 COVID-era in-person visits [26.5%] vs 3633 COVID-era video visits [30.4%] vs 1435 COVID-era telephone visits [35.0%]; P < .001 for all comparisons), have private insurance (34 063 pre-COVID in-person visits [39.1%] vs 25 474 COVID-era in-person visits [34.2%] vs 2562 COVID-era video visits [54.3%] vs 4264 COVID-era telephone visits [41.1%]; P < .001 for COVID-era in-person vs video and COVID-era in-person vs telephone), and have cardiovascular comorbidities (eg, hypertension: 37 166 pre-COVID in-person visits [42.6%] vs 31 359 COVID-era in-person visits [42.1%] vs 2006 COVID-era video visits [42.5%] vs 5181 COVID-era telephone visits [49.9%]; P < .001 for COVID-era in-person vs telephone; and heart failure: 14 319 pre-COVID in-person visits [16.4%] vs 10 488 COVID-era in-person visits [14.1%] vs 1172 COVID-era video visits [24.8%] vs 2674 COVID-era telephone visits [25.8%]; P < .001 for COVID-era in-person vs video and COVID-era in-person vs telephone). After adjusting for patient and visit characteristics and in comparison with pre-COVID in-person visits, during video and telephone visits, clinicians had lower odds of ordering any medication (COVID-era in-person: odds ratio [OR], 0.62 [95% CI, 0.60-0.64], COVID-era video: OR, 0.22 [95% CI, 0.20-0.24]; COVID-era telephone: OR, 0.14 [95% CI, 0.13-0.15]) or tests, such as electrocardiograms (COVID-era in-person: OR, 0.60 [95% CI, 0.58-0.62]; COVID-era video: OR, 0.03 [95% CI, 0.02-0.04]; COVID-era telephone: OR, 0.02 [95% CI, 0.01-0.03]) or echocardiograms (COVID-era in-person: OR, 1.21 [95% CI, 1.18-1.24]; COVID-era video: OR, 0.47 [95% CI, 0.42-0.52]; COVID-era telephone: OR, 0.28 [95% CI, 0.25-0.31]). CONCLUSIONS AND RELEVANCE Patients who were Asian, Black, or Hispanic, had private insurance, and had at least one of several cardiovascular comorbidities used remote cardiovascular care more frequently in the COVID-era period. Clinician ordering of diagnostic testing and medications consistently decreased when comparing pre-COVID vs COVID-era and in-person vs remote visits. Further studies are needed to clarify whether these decreases represent a reduction in the overuse of tests and medications vs an underuse of indicated testing and prescribing.
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Affiliation(s)
- Neal Yuan
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joshua M. Pevnick
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Patrick G. Botting
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yaron Elad
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Shaun J. Miller
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Susan Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joseph E. Ebinger
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Hofstra L, Somsen GA. Telemedicine in post-CABG patients: promises and pitfalls. Neth Heart J 2021; 29:78-79. [PMID: 33475931 PMCID: PMC7818690 DOI: 10.1007/s12471-021-01537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- L Hofstra
- Cardiology Centres of the Netherlands, Amsterdam, The Netherlands.
| | - G A Somsen
- Cardiology Centres of the Netherlands, Amsterdam, The Netherlands
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Zhu Z, Li J, Zhang S, Geng N, Xu L, Greenwald SE. Quality evaluation of signals collected by portable ECG devices using dimensionality reduction and flexible model integration. Physiol Meas 2020; 41:105001. [PMID: 32947264 DOI: 10.1088/1361-6579/abba0b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Portable devices for collecting electrocardiograms (ECGs) and telemedicine systems for diagnosis are available to residents in deprived areas, but ECGs collected by non-professionals are not necessarily reliable and may impair the accuracy of diagnosis. We propose an algorithm for accurate ECG quality assessment, which can help improve the reliability of ECGs collected by portable devices. APPROACH Using challenge data from CinC (2019), signals were classified as 'acceptable' and 'unacceptable' by annotators. The training set contained 998 12-lead ECGs and the test set contained 500. A 998 × 84 feature matrix, S, was formed by feature extraction and three basic models were obtained through training SVM, DT and NBC on S. The feature subsets S1, S2 and S3 were obtained by dimensionality reduction on S using SVM, DT and NBC, respectively. Three other basic models were obtained through training SVM on S1, DT on S2 and NBC on S3. By combining these six basic models, several integrated models were formed. An iterative method was proposed to select the integrated model with the highest accuracy on the training set. Having compared differences between the output labels and the original data labels, evaluation criteria were calculated. MAIN RESULTS An accuracy of 98.70% and 98.60% was achieved on the training and test datasets, respectively. High F1 score and Kappa values were also obtained. SIGNIFICANCE The proposed algorithm has advantages over previously reported approaches during automatic assessment of ECG quality and can thus help to reduce reliance on highly trained professionals when assessing the quality of ECGs.
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Affiliation(s)
- Zeyang Zhu
- Collage of Medicine and Biological Information Engineering, Northeastern University, Shenyang 110819, Liaoning, People's Republic of China
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Brunetti ND, Castrovilli V, Ieva R, Centola A, Garbarino S, Formilli P, Leopizzi A, Rizzon B, Cillo OD. Telecardiology Assessment and Cardiovascular Prevention in Italian Police Officers. Am J Cardiol 2020; 133:179-182. [PMID: 32807389 DOI: 10.1016/j.amjcard.2020.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Riccardo Ieva
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Antonio Centola
- Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy
| | - Sergio Garbarino
- Department of Woman/Child and Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Paola Formilli
- Central Operation Office of State Police for Health, Rome, Italy
| | | | - Brian Rizzon
- Apulia Regional Telecardiology Service, Policlinico Hospital, Bari, Italy
| | - Ottavio Di Cillo
- Apulia Regional Telecardiology Service, Policlinico Hospital, Bari, Italy
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12
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Piera-Jiménez J, Winters M, Broers E, Valero-Bover D, Habibovic M, Widdershoven JWMG, Folkvord F, Lupiáñez-Villanueva F. Changing the Health Behavior of Patients With Cardiovascular Disease Through an Electronic Health Intervention in Three Different Countries: Cost-Effectiveness Study in the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) 2 Randomized Controlled Trial. J Med Internet Res 2020; 22:e17351. [PMID: 32720908 PMCID: PMC7420510 DOI: 10.2196/17351] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/20/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the last few decades, preventing the development of cardiovascular disease has become a mainstay for reducing cardiovascular morbidity and mortality. It has been suggested that interventions should focus more on committed approaches of self-care, such as electronic health techniques. OBJECTIVE This study aimed to provide evidence to understand the financial consequences of implementing the "Do Cardiac Health: Advanced New Generation Ecosystem" (Do CHANGE 2) intervention, which was evaluated in a multisite randomized controlled trial to change the health behavior of patients with cardiovascular disease. METHODS The cost-effectiveness analysis of the Do CHANGE 2 intervention was performed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing tool, based on a Markov model of five health states. The following two types of costs were considered for both study groups: (1) health care costs (ie, costs associated with the time spent by health care professionals on service provision, including consultations, and associated unplanned hospitalizations, etc) and (2) societal costs (ie, costs attributed to the time spent by patients and informal caregivers on care activities). RESULTS The Do CHANGE 2 intervention was less costly in Spain (incremental cost was -€2514.90) and more costly in the Netherlands and Taiwan (incremental costs were €1373.59 and €1062.54, respectively). Compared with treatment as usual, the effectiveness of the Do CHANGE 2 program in terms of an increase in quality-adjusted life-year gains was slightly higher in the Netherlands and lower in Spain and Taiwan. CONCLUSIONS In general, we found that the incremental cost-effectiveness ratio strongly varied depending on the country where the intervention was applied. The Do CHANGE 2 intervention showed a positive cost-effectiveness ratio only when implemented in Spain, indicating that it saved financial costs in relation to the effect of the intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT03178305; https://clinicaltrials.gov/ct2/show/NCT03178305.
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Affiliation(s)
- Jordi Piera-Jiménez
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
- Department of R&D, Badalona Serveis Assistencials, Badalona, Spain
| | | | - Eva Broers
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | | | - Mirela Habibovic
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Jos W M G Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | - Frans Folkvord
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
- Department of Communication and Cognition, Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Francisco Lupiáñez-Villanueva
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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13
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Brunetti ND, Molinari G, Acquistapace F, Zimotti T, Parati G, Indolfi C, Fedele F, Carugo S. 2019 Italian Society of Cardiology Census on telemedicine in cardiovascular disease: a report from the working group on telecardiology and informatics. Open Heart 2020; 7:e001157. [PMID: 32206315 PMCID: PMC7078982 DOI: 10.1136/openhrt-2019-001157] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/21/2019] [Accepted: 02/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this study was to assess by a census supported by the Italian Society of Cardiology (Società Italiana di Cardiologia, SIC) the present implementation of telemedicine in the field of cardiovascular disease in Italy. Methods A dedicated questionnaire was sent by email to all the members of the SIC: data on telemedicine providers, service provided, reimbursement, funding and organisational solutions were collected and analysed. Results Reported telemedicine activities were mostly stable and public hospital based, focused on acute cardiovascular disease and prehospital triage of suspected acute myocardial infarction (prehospital ECG, always interpreted by a cardiologist and not automatically reported by computerised algorithms). Private companies delivering telemedicine services in cardiology (ECGs, ambulatory ECG monitoring) were also present. In 16% of cases, ECGs were also delivered through pharmacies or general practitioners. ICD/CRT-D remote control was performed in 42% of cases, heart failure patient remote monitoring in 37% (21% vital parameters monitoring, 32% nurse telephone monitoring). Telemedicine service was public in 74% of cases, paid by the patient in 26%. About half of telemedicine service received no funding, 17% received State and/or European Union funding. Conclusions Several telemedicine activities have been reported for the management of acute and chronic cardiovascular disease in Italy. The whole continuum of cardiovascular disease is covered by telemedicine solutions. A periodic census may be useful to assess the implementation of guidelines recommendations on telemedicine.
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Affiliation(s)
- Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, Università degli Studi di Foggia, Foggia, Puglia, Italy
| | | | | | - Tecla Zimotti
- Department of Medical and Surgical Sciences, Università degli Studi di Foggia, Foggia, Puglia, Italy
| | - Gianfranco Parati
- Università degli Studi di Milano-Bicocca, Milano, Lombardia, Italy.,Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico, Milano, Lombardia, Italy
| | - Ciro Indolfi
- Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | | | - Stefano Carugo
- Università degli Studi di Milano, Milano, Lombardia, Italy
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14
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Marcolino MS, Maia LM, Oliveira JAQ, Melo LDR, Pereira BLD, Andrade-Junior DF, Boersma E, Ribeiro AL. Impact of telemedicine interventions on mortality in patients with acute myocardial infarction: a systematic review and meta-analysis. Heart 2019; 105:1479-1486. [PMID: 31253696 DOI: 10.1136/heartjnl-2018-314539] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/14/2019] [Accepted: 04/19/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite the promise of telemedicine to improve care for ischaemic heart disease, there are significant obstacles to implementation. Demonstrating improvement in patient-centred outcomes is important to support development of these innovative strategies. OBJECTIVE To assess the impact of telemedicine interventions on mortality after acute myocardial infarction (AMI). METHODS Articles were searched in MEDLINE, Cochrane Central Register of Controlled Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados de Enfermagem (BDENF), Indice Bibliográfico Español en Ciencias de la Salud (IBECs), Web of Science, Scopus and Google Scholar, from January 2004 to January 2018. Study selection and data extraction were performed by two independent reviewers. In-hospital mortality (primary outcome), and door-to-balloon (DTB) time, 30-day mortality and long-term mortality (secondary outcomes) were assessed. Random effects models were applied to estimate pooled results. RESULTS Thirty non-randomised controlled and seven quasi-experimental studies were included (16 960 patients). They were classified as moderate or serious risk of bias by ROBINS-I (Risk Of Bias In Non-randomized Studies-of Interventions tool). In 31 studies, the intervention was prehospital ECG transmission. Telemedicine was associated with reduced in-hospital mortality compared with usual care (relative risk (RR) 0.63(95% confidence interval[CI] 0.55 to 0.72); I2 <0.001%). DTB time was consistently reduced (mean difference -28 (95% CI -35 to -20) min), but showed large heterogeneity (I2=94%). Thirty-day mortality (RR 0.62;95% CI 0.43 to 0.85) and long-term mortality (RR 0.61(95% CI 0.40 to 0.92)) were also reduced, with moderate heterogeneity (I2=52%). CONCLUSIONS There is moderate-quality evidence that telemedicine strategies, in particular ECG transmission, combined with the usual care for AMI are associated with reduced in-hospital mortality and very-low quality evidence that they reduce DTB time, 30-day mortality and long-term mortality.
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Affiliation(s)
- Milena Soriano Marcolino
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciana Marques Maia
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | | | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Antonio Luiz Ribeiro
- Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Real-Time Remote-Health Monitoring Systems: a Review on Patients Prioritisation for Multiple-Chronic Diseases, Taxonomy Analysis, Concerns and Solution Procedure. J Med Syst 2019; 43:223. [PMID: 31187288 DOI: 10.1007/s10916-019-1362-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 05/30/2019] [Indexed: 01/01/2023]
Abstract
Remotely monitoring a patient's condition is a serious issue and must be addressed. Remote health monitoring systems (RHMS) in telemedicine refers to resources, strategies, methods and installations that enable doctors or other medical professionals to work remotely to consult, diagnose and treat patients. The goal of RHMS is to provide timely medical services at remote areas through telecommunication technologies. Through major advancements in technology, particularly in wireless networking, cloud computing and data storage, RHMS is becoming a feasible aspect of modern medicine. RHMS for the prioritisation of patients with multiple chronic diseases (MCDs) plays an important role in sustainably providing high-quality healthcare services. Further investigations are required to highlight the limitations of the prioritisation of patients with MCDs over a telemedicine environment. This study introduces a comprehensive and inclusive review on the prioritisation of patients with MCDs in telemedicine applications. Furthermore, it presents the challenges and open issues regarding patient prioritisation in telemedicine. The findings of this study are as follows: (1) The limitations and problems of existing patients' prioritisation with MCDs are presented and emphasised. (2) Based on the analysis of the academic literature, an accurate solution for remote prioritisation in a large scale of patients with MCDs was not presented. (3) There is an essential need to produce a new multiple-criteria decision-making theory to address the current problems in the prioritisation of patients with MCDs.
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16
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Brunetti ND, Dell'Anno A, Martone A, Natale E, Rizzon B, Di Cillo O, Russo A. Prehospital ECG transmission results in shorter door-to-wire time for STEMI patients in a remote mountainous region. Am J Emerg Med 2019; 38:252-257. [PMID: 31079977 DOI: 10.1016/j.ajem.2019.04.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pre-hospital triage with ECG-transmission may reduce time to reperfusion in patients with ST-elevation acute myocardial infarction (STEMI). Less, however, is known on potential benefit of ECG-transmission triage in mountain areas, with complex orography. METHODS Patients admitted for STEMI and primary coronary angioplasty (pPCI) in a mountain area served by a single cathlab and triaged with ECG-transmission were enrolled in the study and compared with controls: patients' demographics and time to coronary wire were recorded. RESULTS Forty-seven consecutive patients were enrolled in the study: 23 patients following ECG transmission and 24 STEMI patients who presented directly to the Emergency Department. At multivariable regression analysis, pre-hospital ECG-transmission electrocardiogram was an independent predictor of shorter time-to-wire (beta -0.34, p < 0.05). In case of transport times >30 min, ECG-transmission triage achieved time-to-wire times 20% shorter. Excluding unreducible transport time, avoidable delay was reduced by 38% in the whole population, by 48% in case of peripheral areas (transport time > 30 min from cathlab) and elderly (>80 years) patients (p < 0.05 in all cases). CONCLUSIONS Pre-hospital triage with ECG-transmission is associated with shorter ischemic time even in mountain areas with a complex orography profile. The benefit is greater in elderly patients and remote areas.
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Affiliation(s)
| | | | | | - Emanuela Natale
- Cardiology Department, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy.
| | - Brian Rizzon
- Apulia Regional Telecardiology Service, Policlinico Hospital, Bari, Italy
| | - Ottavio Di Cillo
- Apulia Regional Telecardiology Service, Policlinico Hospital, Bari, Italy
| | - Aldo Russo
- Cardiology Department, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Foggia, Italy.
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Albahri OS, Zaidan AA, Zaidan BB, Hashim M, Albahri AS, Alsalem MA. Real-Time Remote Health-Monitoring Systems in a Medical Centre: A Review of the Provision of Healthcare Services-Based Body Sensor Information, Open Challenges and Methodological Aspects. J Med Syst 2018; 42:164. [PMID: 30043085 DOI: 10.1007/s10916-018-1006-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/21/2018] [Indexed: 01/11/2023]
Abstract
Promoting patient care is a priority for all healthcare providers with the overall purpose of realising a high degree of patient satisfaction. A medical centre server is a remote computer that enables hospitals and physicians to analyse data in real time and offer appropriate services to patients. The server can also manage, organise and support professionals in telemedicine. Therefore, a remote medical centre server plays a crucial role in sustainably delivering quality healthcare services in telemedicine. This article presents a comprehensive review of the provision of healthcare services in telemedicine applications, especially in the medical centre server. Moreover, it highlights the open issues and challenges related to providing healthcare services in the medical centre server within telemedicine. Methodological aspects to control and manage the process of healthcare service provision and three distinct and successive phases are presented. The first phase presents the identification process to propose a decision matrix (DM) on the basis of a crossover of 'multi-healthcare services' and 'hospital list' within intelligent data and service management centre (Tier 4). The second phase discusses the development of a DM for hospital selection on the basis of integrated VIKOR-Analytic Hierarchy Process (AHP) methods. Finally, the last phase examines the validation process for the proposed framework.
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Affiliation(s)
- O S Albahri
- Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia
| | - A A Zaidan
- Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia.
| | - B B Zaidan
- Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia
| | - M Hashim
- Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia
| | - A S Albahri
- Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia
| | - M A Alsalem
- Department of Computing, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia
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18
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Deidda M, Meleddu M, Pulina M. Potential users’ preferences towards cardiac telemedicine: A discrete choice experiment investigation in Sardinia. HEALTH POLICY AND TECHNOLOGY 2018. [DOI: 10.1016/j.hlpt.2018.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Usefulness of a Telemedicine Program in Refractory Older Congestive Heart Failure Patients. Diseases 2018; 6:diseases6010010. [PMID: 29361704 PMCID: PMC5871956 DOI: 10.3390/diseases6010010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 12/28/2022] Open
Abstract
Background: Home telemonitoring is a modern and effective disease management model that is able to improve medical care, quality of life, and prognosis of chronically ill patients, and to reduce expenditure. The objective of this study was to evaluate the efficacy, costs, and patients’ and caregivers’ acceptance of our model of telemedicine in a high-risk chronic heart failure (CHF) older population. Methods: Patients with high risk/refractory CHF were included. In the case of alarm parameters’ modifications, a cardiologist decided to inform the emergency department (ED), the patient’s General Practioner, or to programme a clinical ambulatory control. Results: Forty-eight CHF patients (28 males; 58.3%), with a mean age of 80.4 ± 7.7 years, entered this clinical experience. During the 20-months follow-up, four patients dropped out from counselling (8.3%), ambulatory clinical control within-24 h was planned in 18% of patients, 11% of patients were admitted to an ED, and 18% were hospitalized. Thirteen patients (29.5%) died a cardiac death; hospital admissions for heart failure decreased during the year after the enrolment when compared to the year before (from 35 to 12 acute HF hospitalizations/year; p = 0.0001). Moreover, in these HF patients followed, accesses to an ED for an acute episode of HF decompensation reduced from 21/year to five/year (p = 0.0001). The economic expenditure, calculated for the year before and after the enrolment, reduced from 116.856 Euros to 40.065 Euros/year. Conclusions: A telemedicine surveillance in high-risk older CHF patients determines a continuous and active contact between patients/caregivers, the Heart Failure Clinic, and family physicians, permitting an early evaluation of signs and symptoms of acute decompensation.
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20
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Hashemi A, Nourbakhsh S, Tehrani P, Karimi A. Remote telemonitoring of cardiovascular patients: Benefits, barriers, new suggestions. Artery Res 2018. [DOI: 10.1016/j.artres.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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21
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Kalid N, Zaidan AA, Zaidan BB, Salman OH, Hashim M, Muzammil H. Based Real Time Remote Health Monitoring Systems: A Review on Patients Prioritization and Related "Big Data" Using Body Sensors information and Communication Technology. J Med Syst 2017; 42:30. [PMID: 29288419 DOI: 10.1007/s10916-017-0883-4] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
Abstract
The growing worldwide population has increased the need for technologies, computerised software algorithms and smart devices that can monitor and assist patients anytime and anywhere and thus enable them to lead independent lives. The real-time remote monitoring of patients is an important issue in telemedicine. In the provision of healthcare services, patient prioritisation poses a significant challenge because of the complex decision-making process it involves when patients are considered 'big data'. To our knowledge, no study has highlighted the link between 'big data' characteristics and real-time remote healthcare monitoring in the patient prioritisation process, as well as the inherent challenges involved. Thus, we present comprehensive insights into the elements of big data characteristics according to the six 'Vs': volume, velocity, variety, veracity, value and variability. Each of these elements is presented and connected to a related part in the study of the connection between patient prioritisation and real-time remote healthcare monitoring systems. Then, we determine the weak points and recommend solutions as potential future work. This study makes the following contributions. (1) The link between big data characteristics and real-time remote healthcare monitoring in the patient prioritisation process is described. (2) The open issues and challenges for big data used in the patient prioritisation process are emphasised. (3) As a recommended solution, decision making using multiple criteria, such as vital signs and chief complaints, is utilised to prioritise the big data of patients with chronic diseases on the basis of the most urgent cases.
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Affiliation(s)
- Naser Kalid
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia.,Department of Computer Engineering Techniques, Al-Nisour University, Al Adhmia - Haiba Khaton, Baghdad, Iraq
| | - A A Zaidan
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia.
| | - B B Zaidan
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia
| | - Omar H Salman
- Networking Department, Engineering College, Al Iraqia university, Baghdad, Iraq
| | - M Hashim
- Computing Department, Universiti Pendidikan Sultan Idris, Tg Malim, 35900, Perak, Malaysia
| | - H Muzammil
- Department of Computer Science, University of Management and Technology, Lahore, Pakistan
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Di Lenarda A, Casolo G, Gulizia MM, Aspromonte N, Scalvini S, Mortara A, Alunni G, Ricci RP, Mantovan R, Russo G, Gensini GF, Romeo F. The future of telemedicine for the management of heart failure patients: a Consensus Document of the Italian Association of Hospital Cardiologists (A.N.M.C.O), the Italian Society of Cardiology (S.I.C.) and the Italian Society for Telemedicine and eHealth (Digital S.I.T.). Eur Heart J Suppl 2017; 19:D113-D129. [PMID: 28751839 PMCID: PMC5520762 DOI: 10.1093/eurheartj/sux024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Telemedicine applied to heart failure patients is a tool for recording and providing remote transmission, storage and interpretation of cardiovascular parameters and/or useful diagnostic images to allow for intensive home monitoring of patients with advanced heart failure, or during the vulnerable post-acute phase, to improve patient's prognosis and quality of life. Recently, several meta-analyses have shown that telemedicine-supported care pathways are not only effective but also economically advantageous. Benefits seem to be substantial, with a 30-35% reduction in mortality and 15-20% decrease in hospitalizations. Patients implanted with cardiac devices can also benefit from an integrated remote clinical management since all modern devices can transmit technical and diagnostic data. However, telemedicine may provide benefits to heart failure patients only as part of a shared and integrated multi-disciplinary and multi-professional 'chronic care model'. Moreover, the future development of remote telemonitoring programs in Italy will require the primary use of products certified as medical devices, validated organizational solutions as well as legislative and administrative adoption of new care methods and the widespread growth of clinical care competence to remotely manage the complexity of chronicity. Through this consensus document, Italian Cardiology reaffirms its willingness to contribute promoting a new phase of qualitative assessment, standardization of processes and testing of telemedicine-based care models in heart failure. By recognizing the relevance of telemedicine for the care of non-hospitalized patients with heart failure, its strategic importance for the design of innovative models of care, and the many challenges and opportunities it raises, ANMCO and SIC through this document report a consensus on the main directions for its widespread and sustainable clinical implementation.
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Affiliation(s)
- Andrea Di Lenarda
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, Via Slataper, 9 34125 Trieste, Italy
| | - Giancarlo Casolo
- Cardiology Department, Nuovo Ospedale Versilia, Lido di Camaiore (Lucca), Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Nadia Aspromonte
- CCU-Cardiology Department, Presidio Ospedaliero San Filippo Neri, Roma, Italy
| | - Simonetta Scalvini
- Cardiology Department, Cardiac Rehabilitation Division, Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane (Brescia), Italy
| | - Andrea Mortara
- Cardiology Department, Policlinico di Monza, Monza, Italy
| | - Gianfranco Alunni
- Cardiology Department, Integrated Heart Failure Unit, Ospedale di Assisi, Assisi (Perugia)
| | - Renato Pietro Ricci
- CCU-Cardiology Department, Presidio Ospedaliero San Filippo Neri, Roma, Italy
| | - Roberto Mantovan
- Cardiology Unit, Ospedale Santa Maria dei Battuti, Conegliano (Treviso), Italy
| | - Giancarmine Russo
- Italian Society for Telemedicine and eHealth (Digital SIT), Rome, Italy
| | | | - Francesco Romeo
- Cardiology Unit and Interventional Cardiology Department, Policlinico “Tor Vergata”, Rome, Italy
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Molinari G, Molinari M, Di Biase M, Brunetti ND. Telecardiology and its settings of application: An update. J Telemed Telecare 2017; 24:373-381. [PMID: 28084886 DOI: 10.1177/1357633x16689432] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Among the wide range of medical specialties in which telemedicine has been successfully applied, cardiology can be considered as one of the most important fields of application. Through the transmission of clinical data and the electrocardiogram, telecardiology allows access to a real-time assessment (teleconsultation) without any need to travel for both patient and cardiologist. This review discusses the impact of telecardiology in different clinical settings of application. Pre-hospital telecardiology has proved to be useful either in the clinical management of remote patients with acute coronary syndrome or in supporting the decision-making process of general practitioners. In the setting of in-hospital telecardiology, most of the applications refer to real-time echocardiography transmissions between rural small hospitals and tertiary care centres, particularly for the diagnosis or exclusion of congenital heart disease in newborns. Finally, many trials show that post-hospital telecardiology improves outcomes and reduces re-admissions or outpatient contacts in patients with heart failure, arrhythmias or implantable devices.
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Affiliation(s)
| | | | - Matteo Di Biase
- 2 Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Natale D Brunetti
- 2 Department of Medical and Surgical Sciences, University of Foggia, Italy
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Nagayoshi Y, Oshima S, Ogawa H. Response to Pollari et al. re: "Clinical Impact of Telemedicine Network System at Rural Hospitals Without On-Site Cardiac Surgery Backup". Telemed J E Health 2016; 23:260-261. [PMID: 27525984 DOI: 10.1089/tmj.2016.29011.yn] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yasuhiro Nagayoshi
- 1 Department of Cardiovascular Medicine, Aso Medical Center , Aso, Japan .,2 Department of Cerebrovascular and Acute Coronary Syndrome, Graduate School of Medical Sciences, Kumamoto University , Kumamoto, Japan
| | - Shuichi Oshima
- 3 Department of Cardiology, Kumamoto Central Hospital , Kumamoto, Japan
| | - Hisao Ogawa
- 4 Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University , Kumamoto, Japan .,5 Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center , Suita, Japan
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25
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Brunetti ND. Public health: What's app in emergency cardiovascular care? Nat Rev Cardiol 2016; 13:571-2. [PMID: 27510547 DOI: 10.1038/nrcardio.2016.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Natale Daniele Brunetti
- Department of Medical &Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy
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Chair SY, Yu DSF, Ng MT, Wang Q, Cheng HY, Wong EML, Sit JWH. Evolvement of left ventricular assist device: the implications on heart failure management. J Geriatr Cardiol 2016; 13:425-30. [PMID: 27594870 PMCID: PMC4984573 DOI: 10.11909/j.issn.1671-5411.2016.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/16/2016] [Accepted: 03/30/2016] [Indexed: 11/21/2022] Open
Abstract
Heart failure (HF) is a potentially fatal disease that affects increasing number of people worldwide. Although heart transplant is the "gold standard" therapy for HF, due to the limited availability of organs, many patients died when waiting for the transplant. Left ventricular assist device (LVAD), as a mechanical circulatory support, has become a new light for patients with HF. With the technical advancements, LVADs work not only as a bridge to transplant, but also assist heart recovery and even as a destination therapy in long-term treatment. This observation paper reviewed the development of LVAD and its clinical roles. The challenges and possible solutions in nursing care for patients with LVAD at different stage of implantation were discussed. The healthcare professionals could obtain a better understanding about the LVAD treatment for HF patients.
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Affiliation(s)
- Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Doris SF Yu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Michael Timothy Ng
- Department of Psychology, Faculty of Social Science, The Chinese University of Hong Kong, Hong Kong, China
| | - Qun Wang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Eliza ML Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Janet WH Sit
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Abstract
Cardiovascular disease is one of the main fields of application for telemedicine, with benefits in almost all areas in the continuum of cardiovascular disease. The greatest impact has been shown in the early diagnosis of cardiovascular disease, in second consultation, between non-cardiologist and cardiologist and between cardiologists, and in follow-up and secondary prevention of cardiovascular disease. At present, the main area of implementation for telemedicine in cardiovascular disease is represented by pre-hospital triage, with telemedicine electrocardiogram in acute myocardial infarction. Significant results have also been achieved in the second opinion consultation of pediatric subjects with congenital cardiovascular disease, home-monitoring and the management of patients affected by chronic heart failure or with an implanted device. However, there is significant room for further improvement in delivering telemedicine assistance even in 'very-remote' populations, such as detainees, patients in developing countries or in underdeveloped areas of developed countries.
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Affiliation(s)
| | - Simonetta Scalvini
- b U.O. Cardiologia Riabilitativa , IRCCS Fondazione Salvatore Maugeri , Brescia , Italy
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Brunetti ND, Tarantino N, Dellegrottaglie G, Abatecola G, De Gennaro L, Bruno AI, Bux F, Gaglione A, Di Biase M. Impact of telemedicine support by remote pre-hospital electrocardiogram on emergency medical service management of subjects with suspected acute cardiovascular disease. Int J Cardiol 2015. [DOI: 10.1016/j.ijcard.2015.06.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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