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Li R, Wang M, Chen S, Zhang L. Comparative efficacy and adherence of telehealth cardiac rehabilitation interventions for patients with cardiovascular disease: A systematic review and network meta-analysis. Int J Nurs Stud 2024; 158:104845. [PMID: 39032245 DOI: 10.1016/j.ijnurstu.2024.104845] [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: 12/08/2023] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Traditional center-based cardiac rehabilitation had low adherence rates. With the increasing utilization of digital technology in healthcare services, telehealth can overcome common barriers to improve adherence, and some telehealth interventions have been proven safe and effective. However, it remains unclear which telehealth intervention types can maximize the efficacy and adherence for cardiac rehabilitation. OBJECTIVE To compare the effect of different types of telehealth interventions on the efficacy and adherence of patients with cardiovascular disease in cardiac rehabilitation. DESIGN Systematic review and network meta-analysis. METHODS We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, ProQuest, Scopus, and Embase databases for randomized controlled trials of telehealth cardiac rehabilitation for cardiovascular disease patients from January 2013 to March 2024. The primary outcomes were peak oxygen uptake (VO2 peak) and adherence. Secondary outcomes included 6-minute walking distance, moderate-to-vigorous intensity physical activity, depression, self-reported quality of life, and patient satisfaction. The study protocol has been registered on PROSPERO (ID: CRD42023459643). RESULTS This network meta-analysis included 46 randomized controlled trials. The results indicated that telehealth cardiac rehabilitation improved VO2 peak, 6-minute walking distance, moderate-to-vigorous intensity physical activity, and adherence. The surface under the cumulative ranking curve (SUCRA) results showed that the Wearable Devices + Smartphone Applications (SUCRA = 86.8 %, mean rank = 1.7) was the most effective telehealth intervention for improving VO2 peak. The Smartphone Applications + Instant Communication Tools (SUCRA = 74.2 %, mean rank = 2.6) was the most effective telehealth intervention for promoting adherence. CONCLUSIONS Combining two or more types of telehealth interventions was found to be effective. Future efforts should prioritize conducting high-quality randomized controlled trials to identify more effective combinations with traditional cardiac rehabilitation.
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Affiliation(s)
- Ruru Li
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Miao Wang
- The School of Nursing, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Shuoshuo Chen
- The First School of Medicine, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
| | - Liqing Zhang
- The Department of Nursing, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China.
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Chen W, Feng Y, Yu M, Zhang Z, Wu J, Liu W, Gu W. Effects of different rehabilitation modality on cardiopulmonary function in patients with acute coronary syndrome after revascularization. Front Cardiovasc Med 2024; 10:1120665. [PMID: 38500679 PMCID: PMC10945546 DOI: 10.3389/fcvm.2023.1120665] [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: 12/10/2022] [Accepted: 12/04/2023] [Indexed: 03/20/2024] Open
Abstract
Objective To investigate the effects of different rehabilitation modalities on cardiopulmonary function in patients with acute coronary syndrome after revascularization. Methods Two randomized controlled trials were conducted. All patients were stable for more than 48 h and less than 1 week after revascularization for acute coronary syndrome and were randomly assigned to Group A (home-based rehabilitation group) or Group B (center guided home-based rehabilitation group). The cardiopulmonary exercise test was mainly performed before and 3 months after cardiac rehabilitation (at the end of intervention). The primary endpoints of the study were peak oxygen uptake (VO2peak), and the secondary endpoints were maximum metabolic equivalents (METs), anaerobic threshold exercise load (Load AT), maximal workload (Load max), and anaerobic threshold oxygen uptake (VO2 AT). Results A total of 106 patients were included in the study, with 47 patients in Group A (with 6 losses) and 50 patients in Group B (with 3 losses). There were no significant difference between the two groups in terms of age, gender, body mass index (BMI), left ventricular ejection fraction(LVEF), low-density lipoprotein cholesterol(LDL-C),cardiovascular risk factors. In Group A, no significant differences in CPET indices were observed before and after the intervention. In Group B, values of maximum metabolic equivalents (METs), peak heart rate (PHR), anaerobic threshold exercise load (Load AT), maximal workload (Load max), maximum ventilation per minute (VE max), peak oxygen uptake (VO2peak), anaerobic threshold oxygen uptake (VO2 AT) and maximum oxygen pulse (VO2/HRmax) were higher than those before the intervention (P < 0.05). In addition, METs (max), Load AT, Load max, VO2 AT, and VO2peak in Group B were higher than those in group A (P < 0.05). The change rates of VO2peak, METs(max), PHR, Load max, VO2 AT, VE max, VO2/HR(max) in the two groups were significantly different before and after intervention (P < 0.05). Conclusion Cardiac exercise rehabilitation is helpful for improving patients' cardiopulmonary endurance and quality of life. Moreover, rehabilitation modalities with regular hospital guidance can improve cardiopulmonary function in a shorter period,which seems to be more effective than a complete home-based rehabilitation model. Clinical Trial Registration http://www.chictr.org.cn, identifier (ChiCTR2400081034).
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Affiliation(s)
- Wanping Chen
- Cardiac Rehabilitation Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Yan Feng
- Cardiac Rehabilitation Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Meili Yu
- Cardiac Rehabilitation Center, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | - Zhaoguo Zhang
- Cardiac Rehabilitation Center, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | - Jiahui Wu
- Cardiac Rehabilitation Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Wenxian Liu
- Cardiac Rehabilitation Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Wei Gu
- Coronary Heart Disease Center, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Allan LP, Beilei L, Cameron J, Olaiya MT, Silvera-Tawil D, Adcock AK, English C, Gall SL, Cadilhac DA. A Scoping Review of mHealth Interventions for Secondary Prevention of Stroke: Implications for Policy and Practice. Stroke 2023; 54:2935-2945. [PMID: 37800373 DOI: 10.1161/strokeaha.123.043794] [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: 10/07/2023]
Abstract
Secondary prevention is a major priority for those living with stroke and may be improved through the use of mobile Health (mHealth) interventions. While evidence for the effectiveness of mHealth interventions for secondary prevention of stroke is growing, little attention has been given to the translation of these interventions into real-world use. In this review, we aimed to provide an update on the effectiveness of mHealth interventions for secondary prevention of stroke, and investigate their translation into real-world use. Four electronic databases and the gray literature were searched for randomized controlled trials of mHealth interventions for secondary prevention of stroke published between 2010 and 2023. Qualitative and mixed-methods evaluations of the trials were also included. Data were extracted regarding study design, population, mHealth technology involved, the intervention, and outcomes. Principal researchers from these trials were also contacted to obtain further translational information. From 1151 records, 13 randomized controlled trials and 4 evaluations were identified; sample sizes varied widely (median, 56; range, 24-4298). Short message service messages (9/13) and smartphone applications (6/13) were the main technologies used to deliver interventions. Primary outcomes of feasibility of the intervention were achieved in 4 trials, and primary outcomes of changes in risk factors, lifestyle behaviors, and adherence to medication improved in 6 trials. Only 1 trial had a hard end point (ie, stroke recurrence) as a primary outcome, and no significant differences were observed between groups. There was evidence for only 1 intervention being successfully translated into real-world use. Further evidence is required on the clinical effectiveness of mHealth interventions for preventing recurrent stroke, and the associated delivery costs and cost-effectiveness, before adoption into real-world settings.
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Affiliation(s)
- Liam P Allan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Lin Beilei
- The Nursing and Health School, Zhengzhou University, Henan, China (L.B.)
| | - Jan Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Australian Centre for Heart Health, Royal Melbourne Hospital, Victoria, Australia (J.C.)
| | - Muideen T Olaiya
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
| | - David Silvera-Tawil
- Australian e-Health Research Centre, The Commonwealth Scientific and Industrial Research Organisation, New South Wales, Australia (L.P.A., D.S.-T.)
| | - Amelia K Adcock
- Cerebrovascular Division, Department of Neurology, West Virginia University, Morgantown (A.K.A.)
| | - Coralie English
- School of Health Sciences, University of Newcastle, New South Wales, Australia (C.E.)
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New South Wales, Australia (C.E.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.L.G.)
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia (S.L.G.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia (L.P.A., J.C., M.T.O., D.A.C.)
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia (D.A.C.)
- NHMRC Centre of Research Excellence to Accelerate Stroke Trial Innovation and Translation (C.E., D.A.C.)
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4
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Pelly M, Fatehi F, Liew D, Verdejo-Garcia A. Artificial intelligence for secondary prevention of myocardial infarction: A qualitative study of patient and health professional perspectives. Int J Med Inform 2023; 173:105041. [PMID: 36934609 DOI: 10.1016/j.ijmedinf.2023.105041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/30/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Artificial intelligence (AI) has potential to improve self-management of several chronic conditions. However, the perspective of patients and healthcare professionals regarding AI-enabled health management programs, which are key to successful implementation, remains poorly understood. PURPOSE To explore the opinions of people with a history of myocardial infarction (PHMI) and health professionals on the use of AI for secondary prevention of MI. PROCEDURE Three rounds of focus groups were conducted via videoconferencing with 38 participants: 22 PHMI and 16 health professionals. FINDINGS We identified 21 concepts stemming from participants' views, which we classified into five categories: Trust; Expected Functions; Adoption; Concerns; and Perceived Benefits. Trust covered the credibility of information and safety to believe health advice. Expected Functions covered tailored feedback and personalised advice. Adoption included usability features and overall interest in AI. Concerns originated from previous negative experience with AI. Perceived Benefits included the usefulness of AI to provide advice when regular contact with healthcare services is not feasible. Health professionals were more optimistic than PHMI about the usefulness of AI for improving health behaviour. CONCLUSIONS Altogether, our findings provide key insights from end-users to improve the likelihood of successful implementation and adoption of AI-enabled systems in the context of MI, as an exemplar of broader applications in chronic disease management.
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Affiliation(s)
- Melissa Pelly
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
| | - Farhad Fatehi
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC 3800, Australia; The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3800, Australia.
| | - Antonio Verdejo-Garcia
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
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Toh SFM, Chia PF, Fong KNK. Effectiveness of home-based upper limb rehabilitation in stroke survivors: A systematic review and meta-analysis. Front Neurol 2022; 13:964196. [PMID: 36188398 PMCID: PMC9521568 DOI: 10.3389/fneur.2022.964196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Home-based training is an alternative option to provide intensive rehabilitation without costly supervised therapy. Though several studies support the effectiveness of home-based rehabilitation in improving hemiparetic upper limb function in stroke survivors, a collective evaluation of the evidence remains scarce. Objectives This study aims to determine the effects of home-based upper limb rehabilitation for hemiparetic upper limb recovery in stroke survivors. Methods The databases of the Cochrane Library, MEDLINE, CINAHL, and Web of Science were systematically searched from January 2000 to September 2020. Only randomized, controlled, and cross-over trials that evaluated the effects of home-based upper limb interventions were selected. The Pedro scale was used to assess the methodological quality of the studies. A meta-analysis of the upper limb function outcomes was performed by calculating the mean difference/standardized mean difference using a fixed/random effect model. Results An initial search yielded 1,049 articles. Twenty-six articles were included in the review. The pooled evidence of the meta-analysis showed that home-based upper limb intervention was more effective in improving upper limb function [SMD: 0.28, 95% CI (0.12, 0.44), I2 = 0%, p < 0.001, fixed effect model] than conventional therapy. When comparing two types of home-based interventions, subgroup analysis revealed that home-based technology treatment—electrical stimulation—provided more significant improvement in upper limb function than treatment without the use of technology (SMD: 0.64, 95% CI (0.21, 1.07), I2 = 0%, p = 0.003, random effect model). Conclusion The beneficial effects of home-based upper limb interventions were superior to conventional therapy in improving function and perceived use of the hemiparetic upper limb in daily activities. Among the home-based interventions, home-based electrical stimulation seemed to provide the most optimal benefits.
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Affiliation(s)
- Sharon Fong Mei Toh
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Rehabilitation, Yishun Community Hospital, Singapore, Singapore
| | - Pei Fen Chia
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Kenneth N. K. Fong
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Liu D, Li Q, Han S. Using Extended Technology Acceptance Model to Assess the Adopt Intention of a Proposed IoT-Based Health Management Tool. SENSORS (BASEL, SWITZERLAND) 2022; 22:6092. [PMID: 36015853 PMCID: PMC9415274 DOI: 10.3390/s22166092] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Advancements in IoT technology contribute to the digital progress of health science. This paper proposes a cloud-centric IoT-based health management framework and develops a system prototype that integrates sensors and digital technology. The IoT-based health management tool can collect real-time health data and transmit it to the cloud, thus transforming the signals of various sensors into shared content that users can understand. This study explores whether individuals in need tend to use the proposed IoT-based technology for health management, which may lead to the new development of digital healthcare in the direction of sensors. The novelty of this research lies in extending the research perspective of sensors from the technical level to the user level and explores how individuals understand and adopt sensors based on innovatively applying the IoT to health management systems. By organically combining TAM with MOA theory, we propose a comprehensive model to explain why individuals develop perceptions of usefulness, ease of use, and risk regarding systems based on factors related to motivation, opportunity, and ability. Structural equation modeling was used to analyze the online survey data collected from respondents. The results showed that perceived usefulness and ease of use positively impacted adoption intention, Perceived ease of use positively affected perceived usefulness. Perceived risk had a negative impact on adoption intention. Readiness was only positively related to perceived usefulness, while external benefits were positively related to perceived ease of use and negatively related to perceived risk. Facilitative conditions were positively correlated with perceived ease of use and negatively correlated with perceived risk. Technical efficacy was positively related to perceived ease of use and perceived usefulness. Overall, the research model revealed the cognitive mechanism that affects the intention of individuals to use the system combining sensors and the IoT and guides the digital transformation of health science.
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Affiliation(s)
- Dewen Liu
- School of Management, Nanjing University of Posts and Telecommunications, Nanjing 210003, China
| | - Qi Li
- School of Economic Management, Tongji University, Shanghai 200092, China
| | - Shenghao Han
- College of Business, Shanghai University of Finance and Economics, Shanghai 200433, China
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7
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Falter M, Scherrenberg M, Driesen K, Pieters Z, Kaihara T, Xu L, Caiani EG, Castiglioni P, Faini A, Parati G, Dendale P. Smartwatch-Based Blood Pressure Measurement Demonstrates Insufficient Accuracy. Front Cardiovasc Med 2022; 9:958212. [PMID: 35898281 PMCID: PMC9309348 DOI: 10.3389/fcvm.2022.958212] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Novel smartwatch-based cuffless blood pressure (BP) measuring devices are coming to market and receive FDA and CE labels. These devices are often insufficiently validated for clinical use. This study aims to investigate a recently CE-cleared smartwatch using cuffless BP measurement in a population with normotensive and hypertensive individuals scheduled for 24-h BP measurement. Methods Patients that were scheduled for 24-h ambulatory blood pressure monitoring (ABPM) were recruited and received an additional Samsung Galaxy Watch Active 2 smartwatch for simultaneous BP measurement on their opposite arm. After calibration, patients were asked to measure as much as possible in a 24-h period. Manual activation of the smartwatch is necessary to measure the BP. Accuracy was calculated using sensitivity, specificity, positive and negative predictive values and ROC curves. Bland-Altman method and Taffé methods were used for bias and precision assessment. BP variability was calculated using average real variability, standard deviation and coefficient of variation. Results Forty patients were included. Bland-Altman and Taffé methods demonstrated a proportional bias, in which low systolic BPs are overestimated, and high BPs are underestimated. Diastolic BPs were all overestimated, with increasing bias toward lower BPs. Sensitivity and specificity for detecting systolic and/or diastolic hypertension were 83 and 41%, respectively. ROC curves demonstrate an area under the curve (AUC) of 0.78 for systolic hypertension and of 0.93 for diastolic hypertension. BP variability was systematically higher in the ABPM measurements compared to the smartwatch measurements. Conclusion This study demonstrates that the BP measurements by the Samsung Galaxy Watch Active 2 show a systematic bias toward a calibration point, overestimating low BPs and underestimating high BPs, when investigated in both normotensive and hypertensive patients. Standards for traditional non-invasive sphygmomanometers are not met, but these standards are not fully applicable to cuffless devices, emphasizing the urgent need for new standards for cuffless devices. The smartwatch-based BP measurement is not yet ready for clinical usage. Future studies are needed to further validate wearable devices, and also to demonstrate new possibilities of non-invasive, high-frequency BP monitoring.
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Affiliation(s)
- Maarten Falter
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Department of Cardiology, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Martijn Scherrenberg
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
| | - Karen Driesen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Zoë Pieters
- Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Toshiki Kaihara
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Linqi Xu
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- School of Nursing, Jilin University, Changchun, China
| | - Enrico Gianluca Caiani
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Institute of Electronics, Computer and Telecommunication Engineering, Consiglio Nazionale delle Ricerche, Milan, Italy
| | | | - Andrea Faini
- Department of Cardiovascular Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy
| | - Gianfranco Parati
- Department of Cardiovascular Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
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Antoniou V, Xanthopoulos A, Giamouzis G, Davos C, Batalik L, Stavrou V, Gourgoulianis KI, Kapreli E, Skoularigis J, Pepera G. Efficacy, efficiency and safety of a cardiac telerehabilitation programme using wearable sensors in patients with coronary heart disease: the TELEWEAR-CR study protocol. BMJ Open 2022; 12:e059945. [PMID: 35738643 PMCID: PMC9226468 DOI: 10.1136/bmjopen-2021-059945] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Exercise-based cardiac rehabilitation (CR) is a beneficial tool for the secondary prevention of cardiovascular diseases with, however, low participation rates. Telerehabilitation, intergrading mobile technologies and wireless sensors may advance the cardiac patients' adherence. This study will investigate the efficacy, efficiency, safety and cost-effectiveness of a telerehabilitation programme based on objective exercise telemonitoring and evaluation of cardiorespiratory fitness. METHODS AND ANALYSIS A supervised, parallel-group, single-blind randomised controlled trial will be conducted. A total of 124 patients with coronary disease will be randomised in a 1:1 ratio into two groups: intervention telerehabilitation group (TELE-CR) (n=62) and control centre-based cardiac rehabilitation group (CB-CR) (n=62). Participants will receive a 12-week exercise-based rehabilitation programme, remotely monitored for the TELE-CR group and standard supervised for the CB-CR group. All participants will perform aerobic training at 70% of their maximal heart rate, as obtained from cardiopulmonary exercise testing (CPET) for 20 min plus 20 min for strengthening and balance training, three times per week. The primary outcomes will be the assessment of cardiorespiratory fitness, expressed as peak oxygen uptake assessed by the CPET test and the 6 min walk test. Secondary outcomes will be the physical activity, the safety of the exercise intervention (number of adverse events that may occur during the exercise), the quality of life, the training adherence, the anxiety and depression levels, the nicotine dependence and cost-effectiveness. Assessments will be held at baseline, end of intervention (12 weeks) and follow-up (36 weeks). ETHICS AND DISSEMINATION The study protocol has been reviewed and approved by the Ethics Committee of the University of Thessaly (1108/1-12-2021) and by the Ethics Committee of the General University Hospital of Larissa (3780/31-01-2022). The results of this study will be disseminated through manuscript publications and conference presentations. TRIAL REGISTRATION NUMBER NCT05019157.
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Affiliation(s)
- Varsamo Antoniou
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
| | | | - Gregory Giamouzis
- Cardiology, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Constantinos Davos
- Cardiovascular Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Masaryk University Brno, Brno, Czech Republic
| | - Vasileios Stavrou
- Laboratory of Cardio-Pulmonary Testing, Department of Respiratory Medicine, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Konstantinos I Gourgoulianis
- Laboratory of Cardio-Pulmonary Testing, Department of Respiratory Medicine, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
| | - John Skoularigis
- Cardiology, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Garyfallia Pepera
- Clinical Exercise Physiology and Rehabilitation Research Laboratory, Physiotherapy Department, University of Thessaly School of Health Sciences, Lamia, Greece
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Yeung AWK, Kulnik ST, Parvanov ED, Fassl A, Eibensteiner F, Völkl-Kernstock S, Kletecka-Pulker M, Crutzen R, Gutenberg J, Höppchen I, Niebauer J, Smeddinck JD, Willschke H, Atanasov AG. Research on Digital Technology Use in Cardiology: Bibliometric Analysis. J Med Internet Res 2022; 24:e36086. [PMID: 35544307 PMCID: PMC9133979 DOI: 10.2196/36086] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/11/2022] Open
Abstract
Background Digital technology uses in cardiology have become a popular research focus in recent years. However, there has been no published bibliometric report that analyzed the corresponding academic literature in order to derive key publishing trends and characteristics of this scientific area. Objective We used a bibliometric approach to identify and analyze the academic literature on digital technology uses in cardiology, and to unveil popular research topics, key authors, institutions, countries, and journals. We further captured the cardiovascular conditions and diagnostic tools most commonly investigated within this field. Methods The Web of Science electronic database was queried to identify relevant papers on digital technology uses in cardiology. Publication and citation data were acquired directly from the database. Complete bibliographic data were exported to VOSviewer, a dedicated bibliometric software package, and related to the semantic content of titles, abstracts, and keywords. A term map was constructed for findings visualization. Results The analysis was based on data from 12,529 papers. Of the top 5 most productive institutions, 4 were based in the United States. The United States was the most productive country (4224/12,529, 33.7%), followed by United Kingdom (1136/12,529, 9.1%), Germany (1067/12,529, 8.5%), China (682/12,529, 5.4%), and Italy (622/12,529, 5.0%). Cardiovascular diseases that had been frequently investigated included hypertension (152/12,529, 1.2%), atrial fibrillation (122/12,529, 1.0%), atherosclerosis (116/12,529, 0.9%), heart failure (106/12,529, 0.8%), and arterial stiffness (80/12,529, 0.6%). Recurring modalities were electrocardiography (170/12,529, 1.4%), angiography (127/12,529, 1.0%), echocardiography (127/12,529, 1.0%), digital subtraction angiography (111/12,529, 0.9%), and photoplethysmography (80/12,529, 0.6%). For a literature subset on smartphone apps and wearable devices, the Journal of Medical Internet Research (20/632, 3.2%) and other JMIR portfolio journals (51/632, 8.0%) were the major publishing venues. Conclusions Digital technology uses in cardiology target physicians, patients, and the general public. Their functions range from assisting diagnosis, recording cardiovascular parameters, and patient education, to teaching laypersons about cardiopulmonary resuscitation. This field already has had a great impact in health care, and we anticipate continued growth.
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Affiliation(s)
- Andy Wai Kan Yeung
- Division of Oral and Maxillofacial Radiology, Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.,Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Stefan Tino Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Emil D Parvanov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, Varna, Bulgaria
| | - Anna Fassl
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Sabine Völkl-Kernstock
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Maria Kletecka-Pulker
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Institute for Ethics and Law in Medicine, University of Vienna, Vienna, Austria
| | - Rik Crutzen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Johanna Gutenberg
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Isabel Höppchen
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,Center for Human Computer Interaction, Paris Lodron University Salzburg, Salzburg, Austria
| | - Josef Niebauer
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria.,University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria.,REHA Zentrum Salzburg, Salzburg, Austria
| | - Jan David Smeddinck
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University Vienna, Vienna, Austria
| | - Atanas G Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria.,Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Jastrzebiec, Poland
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10
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Meddar JM, Ponnapalli A, Azhar R, Turchioe MR, Duran AT, Creber RM. A Structured Review of Commercially Available Cardiac Rehabilitation mHealth Applications Using the Mobile Application Rating Scale. J Cardiopulm Rehabil Prev 2022; 42:141-147. [PMID: 35135963 PMCID: PMC11086945 DOI: 10.1097/hcr.0000000000000667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study systematically evaluated the quality and functionalities of patient-facing, commercially available mobile health (mHealth) apps for cardiac rehabilitation (CR). METHODS We performed our search in two of the most widely used commercial mobile app stores: Apple iTunes Appstore and Google Play Store (Android apps). Six search terms were used to query relevant CR apps: "cardiac rehabilitation," "heart disease and remote therapy," "heart failure exercise," "heart therapy and cardiac recovery," "cardiac recovery," and "heart therapy." App quality was evaluated using the Mobile Application Rating Scale (MARS). App functionality was evaluated using the IQVIA functionality scale, and app content was evaluated against the American Heart Association guidelines for CR. Apps meeting our inclusion criteria were downloaded and evaluated by two to three reviewers, and interclass correlations between reviewers were calculated. RESULTS We reviewed 3121 apps and nine apps met our inclusion criteria. On average, the apps scored a 3.0 on the MARS (5-point Likert scale) for overall quality. The two top-ranking mHealth apps for CR for all three quality, functionality, and consistency with evidence-based guidelines were My Cardiac Coach and Love My Heart for Women, both of which scored ≥4.0 for behavior change. CONCLUSION Overall, the quality and functionality of free apps for mobile CR was high, with two apps performing the best across all three quality categories. High-quality CR apps are available that can expand access to CR for patients with cardiovascular disease.
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Affiliation(s)
- John M Meddar
- Department of Population Health Sciences, New York University Grossman School of Medicine, New York (Mr Meddar); Department of Population Health Sciences, Weill Cornell Medicine, New York, New York (Mr Ponnapalli, Ms Azhar, and Drs Turchioe and Creber); and Center for Behavioral Cardiovascular Health, Columbia Irving Medical Center, New York, New York (Dr Duran)
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11
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Adedinsewo DA, Pollak AW, Phillips SD, Smith TL, Svatikova A, Hayes SN, Mulvagh SL, Norris C, Roger VL, Noseworthy PA, Yao X, Carter RE. Cardiovascular Disease Screening in Women: Leveraging Artificial Intelligence and Digital Tools. Circ Res 2022; 130:673-690. [PMID: 35175849 PMCID: PMC8889564 DOI: 10.1161/circresaha.121.319876] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease remains the leading cause of death in women. Given accumulating evidence on sex- and gender-based differences in cardiovascular disease development and outcomes, the need for more effective approaches to screening for risk factors and phenotypes in women is ever urgent. Public health surveillance and health care delivery systems now continuously generate massive amounts of data that could be leveraged to enable both screening of cardiovascular risk and implementation of tailored preventive interventions across a woman's life span. However, health care providers, clinical guidelines committees, and health policy experts are not yet sufficiently equipped to optimize the collection of data on women, use or interpret these data, or develop approaches to targeting interventions. Therefore, we provide a broad overview of the key opportunities for cardiovascular screening in women while highlighting the potential applications of artificial intelligence along with digital technologies and tools.
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Affiliation(s)
- Demilade A. Adedinsewo
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Amy W. Pollak
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Sabrina D. Phillips
- Department of Cardiovascular Medicine (D.A.A., A.W.P., S.D.P.), Mayo Clinic, Jacksonville, FL
| | - Taryn L. Smith
- Division of General Internal Medicine (T.L.S.), Mayo Clinic, Jacksonville, FL
| | - Anna Svatikova
- Department of Cardiovascular Diseases (A.S.), Mayo Clinic, Phoenix, AZ
| | - Sharonne N. Hayes
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Sharon L. Mulvagh
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada (S.L.M.)
| | - Colleen Norris
- Cardiovascular Health and Stroke Strategic Clinical Network, Edmonton, Canada (C.N.)
| | - Veronique L. Roger
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
- Department of Quantitative Health Sciences (V.L.R.), Mayo Clinic, Rochester, MN
- Epidemiology and Community Health Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (V.L.R.)
| | - Peter A. Noseworthy
- Department of Cardiovascular Medicine (S.N.H., S.L.M., V.L.R., P.A.N.), Mayo Clinic, Rochester, MN
| | - Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (X.Y.), Mayo Clinic, Rochester, MN
| | - Rickey E. Carter
- Department of Quantitative Health Sciences (R.E.C.), Mayo Clinic, Jacksonville, FL
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12
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Vilela EM, Ladeiras-Lopes R, Joao A, Braga J, Torres S, Viamonte S, Ribeiro J, Teixeira M, Nunes JP, Fontes-Carvalho R. Current role and future perspectives of cardiac rehabilitation in coronary heart disease. World J Cardiol 2021; 13:695-709. [PMID: 35070112 PMCID: PMC8716974 DOI: 10.4330/wjc.v13.i12.695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/08/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023] Open
Abstract
Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.
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Affiliation(s)
- Eduardo M Vilela
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Ricardo Ladeiras-Lopes
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Ana Joao
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Joana Braga
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Susana Torres
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Sofia Viamonte
- Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4405-565, Portugal
| | - José Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - Madalena Teixeira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
| | - José P Nunes
- Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia 4434-502, Portugal
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
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13
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Thomas RJ, Petersen CE, Olson TP, Beatty AL, Ding R, Supervia M. Asynchronous and Synchronous Delivery Models for Home-Based Cardiac Rehabilitation: A SCIENTIFIC REVIEW. J Cardiopulm Rehabil Prev 2021; 41:407-412. [PMID: 34727559 PMCID: PMC9355022 DOI: 10.1097/hcr.0000000000000656] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To review the principles, advantages, and disadvantages of asynchronous and synchronous delivery models of home-based cardiac rehabilitation (HBCR). METHODS We reviewed recently published systematic reviews and other publications of randomized studies of asynchronous and synchronous HBCR to assess principles, outcomes, and limitations of those delivery methods compared with center-based cardiac rehabilitation (CBCR). SUMMARY While most studies prior to 2016 involved asynchronous HBCR approaches to care, studies since 2016 have included asynchronous or synchronous delivery models. Both delivery models have been shown to help provide core components of cardiac rehabilitation (CR). Studies using either method have been shown to have similar short-term patient outcomes as CBCR, at least in low- to moderate-risk patients who have been studied. Asynchronous HBCR offers greater flexibility for patients and CR staff, while synchronous HBCR provides greater real-time oversight and feedback to patients.Asynchronous and synchronous HBCR is an option to consider for patients eligible for CR. Additional research is needed for both delivery models, applied separately or in combination, to compare their impact on shorter- and longer-term patient outcomes and to assess their impact in patient subgroups (referral diagnosis, women, elderly, underrepresented racial and ethnic minority groups, patients at a higher cardiovascular disease risk, patients with multiple comorbid conditions, etc).
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Affiliation(s)
- Randal J Thomas
- Cardiac Rehabilitation Program, Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Thomas and Olson and Ms Petersen); Brigham Young University, Provo, Utah (Ms Petersen); Department of Epidemiology and Biostatistics and Department of Medicine (Cardiology), University of California, San Francisco (Dr Beatty); Department of Cardiology, Peiking University People's Hospital, Beijing, China (Dr Ding); and Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain (Dr Supervia)
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14
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Sotirakos S, Fouda B, Mohamed Razif NA, Cribben N, Mulhall C, O'Byrne A, Moran B, Connolly R. Harnessing artificial intelligence in cardiac rehabilitation, a systematic review. Future Cardiol 2021; 18:154-164. [PMID: 33860679 DOI: 10.2217/fca-2021-0010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This systematic review aims to evaluate the current body of research surrounding the efficacy of artificial intelligence (AI) in cardiac rehabilitation. Presently, AI can be incorporated into personal devices such as smart watches and smartphones, in diagnostic and home monitoring devices, as well as in certain inpatient care settings. Materials & methods: The PRISMA guidelines were followed in this review. Inclusion and exclusion criteria were set using the Population, Intervention, Comparison and Outcomes (PICO) tool. Results: Eight studies meeting the inclusion criteria were found. Conclusion: Incorporation of AI into healthcare, cardiac rehabilitation delivery, and monitoring holds great potential for early detection of cardiac events, allowing for home-based monitoring, and improved clinician decision making.
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Affiliation(s)
- Sara Sotirakos
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - Basem Fouda
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | | | | | - Cormac Mulhall
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - Aisling O'Byrne
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - Bridget Moran
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - Ruairi Connolly
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland.,National Rehabilitation Hospital, Dublin, Ireland
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