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Ramos SR, Reynolds H, Johnson C, Melkus G, Kershaw T, Thayer J, Vorderstrasse A. Perceptions on HIV-related Comorbidities and Usability of a Virtual Environment as CVD Prevention Education in Sexual Minority Men with HIV: Formative Phases of a Pilot RCT. J Med Internet Res 2024. [PMID: 38924481 DOI: 10.2196/57351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Sexual minority men with HIV are at increased risk of cardiovascular disease (CVD) and have been underrepresented in behavioral research and in clinical trials. OBJECTIVE To explore perceptions about HIV-related comorbidities and assess the interest and usability of a virtual environment as CVD prevention education in Black and Latinx sexual minority men with HIV. METHODS This is a 3-phase pilot randomized control behavioral trial. We report on formative phases 1 and 2 that informed virtual environment content and features using qualitative interviews, usability testing, and beta testing with 25 individuals. In Phase 1, 15 participants completed interviews exploring HIV-related illnesses of concern that would be used to tailor the virtual environment. In Phase 2, usability and beta testing were conducted with 10 participants to assess interest, features, and content. RESULTS In Phase 1, we found CVD risk factors included high blood pressure, heart attack, stroke, and diabetes. Cancer (prostate, colon, and others) was a common concern and so were the development of mental health conditions. In Phase 2, all participants completed the 12-item usability checklist with favorable feedback within 30 to 60 minutes. Beta-testing interviews suggested: 1) Mixed perceptions about health and HIV, 2) High risk for comorbid conditions, 3) Virtual environment features were promising, and 4) need for diverse avatar representations. CONCLUSIONS We identified several comorbid conditions of concern and findings carry significant implications for mitigating barriers to preventative health screenings given the shared risk factors between HIV and related comorbidities. Highly rated aspects of the virtual environment were anonymity, meeting others who identify as gay or bisexual with HIV, validating LGBTQ+ images and content, and accessibility to CVD prevention education. Critical end-user feedback from beta-testing suggested more options for avatar customization in skin, hair, body representation. Our next phase will test the virtual environment as a new approach to advancing cardiovascular health equity in ethnic and racial sexual minority men with HIV. CLINICALTRIAL clinicaltrials.gov (NCT04061915). INTERNATIONAL REGISTERED REPORT RR2-10.2196/38348.
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Affiliation(s)
- S Raquel Ramos
- School of Nursing, Yale University, 400 West Campus Drive, Orange, US
- School of Public Health, Social and Behavioral Sciences, Yale University, New Haven, US
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, US
| | - Harmony Reynolds
- Department of Medicine, Grossman School of Medicine, New York, US
- Cardiovascular Clinical Research Center, NYU Langone Health, New York, US
| | - Constance Johnson
- Czik School of Nursing, The University of Texas Health Science Center at Houston, Houston, US
- McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, US
| | - Gail Melkus
- Rory Myers College of Nursing, New York University, New York, US
| | - Trace Kershaw
- School of Public Health, Social and Behavioral Sciences, Yale University, New Haven, US
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, US
| | - Julian Thayer
- School of Social Ecology, Psychological Science, University of California, Irvine, US
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Mouselimis D, Tsarouchas A, Vassilikos VP, Mitsas AC, Lazaridis C, Androulakis E, Briasoulis A, Kampaktsis P, Papadopoulos CE, Bakogiannis C. The role of patient-oriented mHealth interventions in improving heart failure outcomes: A systematic review of the literature. Hellenic J Cardiol 2024; 77:81-92. [PMID: 37926237 DOI: 10.1016/j.hjc.2023.11.001] [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: 08/08/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023] Open
Abstract
Heart failure (HF) is a debilitating disease with 26 million patients worldwide. Consistent and complex self-care is required on the part of patients to adequately adhere to medication and to the lifestyle changes that the disease necessitates. Mobile health (mHealth) is being increasingly incorporated in patient interventions in HF, as smartphones prove to be ideal platforms for patient education and self-help assistance. This systematic review aims to summarize and report on all studies that have tested the effect of mHealth on HF patient outcomes. Our search yielded 17 studies, namely 11 randomized controlled trials and six non-randomized prospective studies. In these, patients with the assistance of an mHealth intervention regularly measured their blood pressure and/or body weight and assessed their symptoms. The outcomes were mostly related to hospitalizations, clinical biomarkers, patients' knowledge about HF, quality of life (QoL) and quality of self-care. QoL consistently increased in patients who received mHealth interventions, while study results on all other outcomes were not as ubiquitously positive. The first mHealth interventions in HF were not universally successful in improving patient outcomes but provided valuable insights for patient-oriented application development. Future trials are expected to build on these insights and deploy applications that measurably assist HF patients.
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Affiliation(s)
- Dimitrios Mouselimis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Tsarouchas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Angelos C Mitsas
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Charalampos Lazaridis
- Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanuel Androulakis
- Heart Imaging Centre, Royal Brompton, and Harefield Hospitals, London, United Kingdom
| | - Alexandros Briasoulis
- University of Iowa Hospitals & Clinics and the National and Kapodistrian University of Athens, Athens, Greece
| | - Polydoros Kampaktsis
- Division of Cardiology, New York University Langone Medical Center, New York, NY, USA
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Khosravirad Z, Rostamzadeh M, Azizi S, Khodashenas M, Khodadoustan Shahraki B, Ghasemi F, ghorbanzadeh M. The Efficacy of Self-care Behaviors, Educational Interventions, and Follow-up Strategies on Hospital Readmission and Mortality Rates in Patients with Heart Failure. Galen Med J 2023; 12:1-7. [PMID: 38774856 PMCID: PMC11108665 DOI: 10.31661/gmj.v12i.3116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Indexed: 05/24/2024] Open
Abstract
Heart failure (HF), a worldwide epidemic with significant morbidity and mortality risks, is frequently secondary to cardiovascular disorders and probably is the common final way to survive patients. Almost 25% of hospitalized patients with acute HF are expected to be readmitted within 30 days post-discharge, and the rates of rehospitalization increase to almost one-third at 60 days and 60 percent within one year of discharge. Although care planning for patients with heart failure is complex, multidisciplinary, and resource-dependent, optimal self-care management along with appropriate educational intervention and follow-up strategy could be able to reduce readmissions, decline the duration of hospitalization, increase life expectancy, decrease the rates of mortality, and reduce costs of healthcare services for patients with HF. However, there are contradictions in previous reports about the efficacy of self-care, mainly due to patients' non-adherence to self-care behaviors. Therefore, the current study aimed to review the investigations on the effectiveness of self-care of HF patients in reducing hospital readmissions and increasing quality of life, and discuss novel approaches for predischarge educational interventions and postdischarge follow-up strategies.
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Affiliation(s)
| | - Mohammad Rostamzadeh
- Department of Cardiology, School of Medicine, Ardabil University of Medical
Sciences, Ardabil, Iran
| | - Shiva Azizi
- Department of Nursing, School of Nursing, North Khorasan University of Medical
Sciences, Bojnurd, Iran
| | | | | | - Farangis Ghasemi
- Department of Biology, Jahrom Branch, Islamic Azad University, Jahrom, Iran
| | - Maryam ghorbanzadeh
- Department of Nursing, School of Nursing, North Khorasan University of Medical
Sciences, Bojnurd, Iran
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Fernández-Gutiérrez M, Bas-Sarmiento P, Jesús Marín-Paz A, Castro-Yuste C, Sánchez-Sánchez E, Hernández-Encuentra E, Jesus Vinolo-Gil M, Carmona-Barrientos I, Poza-Méndez M. Self-management in heart failure using mHealth: A content validation. Int J Med Inform 2023; 171:104986. [PMID: 36638582 DOI: 10.1016/j.ijmedinf.2023.104986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
AIM To describe the development of a mobile health application -mICardiApp- designed by a multidisciplinary professional team and patients with heart failure and to evaluate its content validity. METHODS Critical reviews of the literature, semi-structured interviews with patients, and user stories guided the development of the content of the mobile application. These contents were refined and validated through a modified Delphi process. An expert panel of healthcare and social care professionals together with patients and academics evaluated the content through two content validity indicators, relevance, and adequacy, and provided narrative feedback. The content validity of the app and each screen was determined by calculating the Content Validity Index (CVI). Similarly, the Adequacy Index (AI) was analyzed. RESULTS The developed app is composed by 8 topics: (1) available resources, (2) cardiac rehabilitation, (3) control of signs and symptoms, (4) emotional support, (5) learning and having fun, (6) medication, (7) nutrition, and (8) physical activity. The results demonstrated high CVI of the screens and the full app. 57 of the 59 screens in the app reached an excellent CVI ≥ 0.70 for both relevance and adequacy, except for 2 screens. The CVI Average Method of the app was 0.851. CONCLUSIONS mICardiApp is presented as an application to improve health literacy and self-management of patients with multimorbidity and heart failure, with proven validation.
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Affiliation(s)
- Martina Fernández-Gutiérrez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Pilar Bas-Sarmiento
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain.
| | - Antonio Jesús Marín-Paz
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; The University Research Institute for Sustainable Social Development, INDESS, Spain
| | - Cristina Castro-Yuste
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Eduardo Sánchez-Sánchez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | | | - Maria Jesus Vinolo-Gil
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Inés Carmona-Barrientos
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Miriam Poza-Méndez
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain; The University Research Institute for Sustainable Social Development, INDESS, Spain
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Ding X, Wen Y, Tian Z, Wen Y, Sun G, Geng R, Fang W, Xu Y. Effect of e-health intervention on disease management in patients with chronic heart failure: A meta-analysis. Front Cardiovasc Med 2023; 9:1053765. [PMID: 36824289 PMCID: PMC9941331 DOI: 10.3389/fcvm.2022.1053765] [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: 09/26/2022] [Accepted: 12/21/2022] [Indexed: 02/10/2023] Open
Abstract
Objective The aim of this meta-analysis was to assess the impact of e-health interventions on disease management in patients with CHF. Methods Six databases including Embase, Web of Science, Scopus, PubMed, Cochrane, and EBSCO were searched by computer. The search time is before May 1, 2022. Odds ratios (OR) were used for binary categorical data and weighted mean differences (WMD) for continuous variables. The 95% confidence intervals (CI) were used to express the effect sizes for both count and measurement data. RevMan 5.4 and Stata 16.0 were employed to complete this meta-analysis. Results The study included 22 research studies and 5,149 patients. e-health intervention can effectively reduce all-cause mortality [OR = 0.801, 95%CI: (0.650, 0.987), P < 0.05], all-cause hospitalization rate [OR = 0.66, 95%CI: (0.46, 0.95), P < 0.05] and heart failure related hospitalization rate [OR = 0.750, 95%CI: (0.632, 0.891), P < 0.05]. e-health intervention is also effective in improving the quality of life [WMD = 2.97, 95%CI: (1.54, 4.40), P < 0.05] and the self-management ability of patients [WMD = -2.76, 95%CI: (-5.52, -0.11), P < 0.05]. Conclusion e-health interventions can reduce all-cause mortality, all-cause hospitalization, and heart failure-related hospitalization in patients with CHF. Furthermore, it can improve the health-related quality of life of patients.
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Affiliation(s)
- Xueying Ding
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Yating Wen
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Zimeng Tian
- College of Integrated Chinese and Western Medicine, Jining Medical University, Jining, Shandong, China
| | - Yaru Wen
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Guokun Sun
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Rongxing Geng
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Wei Fang
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Yun Xu
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, China,*Correspondence: Yun Xu ✉
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Li Z, Long Y, Yang Q, Liu J, Wang Y. Smartphone-based interventions in the secondary prevention of cardiovascular disease: A meta-analysis. Technol Health Care 2023; 31:1935-1948. [PMID: 37125588 DOI: 10.3233/thc-230022] [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] [Indexed: 05/02/2023]
Abstract
BACKGROUND A variety of reviews have indicated the effectiveness of smartphone-based interventions in preventing secondary cardiovascular disease (CVD). However, few studies have focused on clinical outcomes. OBJECTIVE This meta-analysis aimed to evaluate the potential benefits of application interventions and short message service (SMS) interventions on CVD outcomes. METHODS Electronic databases were searched to identify randomized controlled trials (RCT) investigating an application or SMS intervention for secondary CVD prevention. Primary outcomes included major adverse cardiovascular events (MACE), cardiovascular death, and cardiac hospitalization. Secondary outcomes were cardiovascular risk factors (BMI, blood pressure, and cholesterol). RESULTS A total of 26 RCTs were included, with 16 investigating applications and 10 assessing SMS. Overall, there was no significant difference in MACE, cardiovascular death, and cardiac hospitalization when comparing application interventions with usual care, as well as comparing SMS with usual care. Subgroup analysis revealed that patients who received applications without a medical interface had a significantly lower incidence of MACE (OR = 0.56; 95% CI: 0.33, 0.98). Participants who received applications with a medical interface showed a tendency towards higher rates of cardiac hospitalization (OR = 2.03; 95% CI: 0.85, 4.87). Significant reduction in waist circumference (SMD =-0.80; 95% CI: -1.58, -0.03) was found in application interventions compared to usual care; while significant reductions in SBP (SMD =-0.08; 95% CI: -0.15, -0.01) and TC (SMD =-0.31; 95% CI: -0.57, -0.08) were found in SMS interventions compared to usual care. CONCLUSION Smartphone-based interventions, including applications and SMS, have the potential to benefit the secondary prevention of CVD. Applications may reduce the incidence of cardiovascular-related adverse events, while SMS interventions may improve cardiovascular risk factors.
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Affiliation(s)
- Zishuo Li
- Department of Administrative Office, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Yanli Long
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Qing Yang
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Jing Liu
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
| | - Yahong Wang
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, Hubei, China
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Fantin F, Giani A, Franconi A, Zoico E, Urbani S, Rossi AP, Mazzali G, Zamboni M. Arterial Stiffness, Subendocardial Impairment, and 30-Day Readmission in Heart Failure Older Patients. Front Cardiovasc Med 2022; 9:918601. [PMID: 35783827 PMCID: PMC9249084 DOI: 10.3389/fcvm.2022.918601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Arterial stiffness and subendocardial perfusion impairment may play a significant role in heart failure (HF) outcomes. The aim of the study was to examine the main predictors of 30-day readmission in geriatric patients, hospitalized with HF, explore hemodynamical parameters, arterial stiffness indexes, and subendocardial viability ratio (SEVR). In total, 41 hospitalized patients, affected by HF, were included; they underwent clinical evaluation, routine laboratory testing, and echocardiography. At the time of admission, after the achievement of clinical stability (defined as switching from intravenous to oral diuretic therapy), and at discharge, arterial tonometry was performed to evaluate carotid-femoral pulse wave velocity (PWVcf) and SEVR (then corrected for hemoglobin concentration and oxygen saturation). Through the evaluations, a significant progressive decrease in PWVcf was described (17.79 ± 4.49, 13.54 ± 4.54, and 9.94 ± 3.73 m/s), even after adjustment for age, gender, mean arterial pressure (MAP) variation, and left ventricular ejection fraction (LVEF). A significant improvement was registered for both SEVR (83.48 ± 24.43, 97.94 ± 26.84, and 113.29 ± 38.02) and corrected SEVR (12.74 ± 4.69, 15.71 ± 5.30, and 18.55 ± 6.66) values, and it was still significant when adjusted for age, gender, MAP variation, and LVEF. After discharge, 26.8% of patients were readmitted within 30 days. In a multivariate binary logistic regression analysis, PWVcf at discharge was the only predictor of 30-day readmission (odds ratio [OR] 1.957, 95% CI 1.112–3.443). In conclusion, medical therapy seems to improve arterial stiffness and subendocardial perfusion in geriatric patients hospitalized with heart failure. Furthermore, PWVcf is a valid predictor of 30-day readmission. Its feasibility in clinical practice may provide an instrument to detect patients with HF at high risk of rehospitalization.
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Affiliation(s)
- Francesco Fantin
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
- *Correspondence: Francesco Fantin,
| | - Anna Giani
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Arianna Franconi
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Elena Zoico
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Silvia Urbani
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Andrea P. Rossi
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Gloria Mazzali
- Section of Geriatric Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Zamboni
- Section of Geriatric Medicine, Department of Surgery, Dentistry, Pediatric, and Gynecology, University of Verona, Verona, Italy
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