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Ferguson C, Shaikh F, Allida SM, Hendriks J, Gallagher C, Bajorek BV, Donkor A, Inglis SC. Clinical service organisation for adults with atrial fibrillation. Cochrane Database Syst Rev 2024; 7:CD013408. [PMID: 39072702 PMCID: PMC11285297 DOI: 10.1002/14651858.cd013408.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) is an increasingly prevalent heart rhythm condition in adults. It is considered a common cardiovascular condition with complex clinical management. The increasing prevalence and complexity in management underpin the need to adapt and innovate in the delivery of care for people living with AF. There is a need to systematically examine the optimal way in which clinical services are organised to deliver evidence-based care for people with AF. Recommended approaches include collaborative, organised multidisciplinary, and virtual (or eHealth/mHealth) models of care. OBJECTIVES To assess the effects of clinical service organisation for AF versus usual care for people with all types of AF. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL to October 2022. We also searched ClinicalTrials.gov and the WHO ICTRP to April 2023. We applied no restrictions on date, publication status, or language. SELECTION CRITERIA We included randomised controlled trials (RCTs), published as full texts and as abstract only, involving adults (≥ 18 years) with a diagnosis of any type of AF. We included RCTs comparing organised clinical service, disease-specific management interventions (including e-health models of care) for people with AF that were multicomponent and multidisciplinary in nature to usual care. DATA COLLECTION AND ANALYSIS Three review authors independently selected studies, assessed risk of bias, and extracted data from the included studies. We calculated risk ratio (RR) for dichotomous data and mean difference (MD) or standardised mean difference (SMD) for continuous data with 95% confidence intervals (CIs) using random-effects analyses. We then calculated the number needed to treat for an additional beneficial outcome (NNTB) using the RR. We performed sensitivity analyses by only including studies with a low risk of selection and attrition bias. We assessed heterogeneity using the I² statistic and the certainty of the evidence according to GRADE. The primary outcomes were all-cause mortality and all-cause hospitalisation. The secondary outcomes were cardiovascular mortality, cardiovascular hospitalisation, AF-related emergency department visits, thromboembolic complications, minor cerebrovascular bleeding events, major cerebrovascular bleeding events, all bleeding events, AF-related quality of life, AF symptom burden, cost of intervention, and length of hospital stay. MAIN RESULTS We included 8 studies (8205 participants) of collaborative, multidisciplinary care, or virtual care for people with AF. The average age of participants ranged from 60 to 73 years. The studies were conducted in China, the Netherlands, and Australia. The included studies involved either a nurse-led multidisciplinary approach (n = 4) or management using mHealth (n = 2) compared to usual care. Only six out of the eight included studies could be included in the meta-analysis (for all-cause mortality and all-cause hospitalisation, cardiovascular mortality, cardiovascular hospitalisation, thromboembolic complications, and major bleeding), as quality of life was not assessed using a validated outcome measure specific for AF. We assessed the overall risk of bias as high, as all studies had at least one domain at unclear or high risk of bias rating for performance bias (blinding) in particular. Organised AF clinical services probably result in a large reduction in all-cause mortality (RR 0.64, 95% CI 0.46 to 0.89; 5 studies, 4664 participants; moderate certainty evidence; 6-year NNTB 37) compared to usual care. However, organised AF clinical services probably make little to no difference to all-cause hospitalisation (RR 0.94, 95% CI 0.88 to 1.02; 2 studies, 1340 participants; moderate certainty evidence; 2-year NNTB 101) and may not reduce cardiovascular mortality (RR 0.64, 95% CI 0.35 to 1.19; 5 studies, 4564 participants; low certainty evidence; 6-year NNTB 86) compared to usual care. Organised AF clinical services reduce cardiovascular hospitalisation (RR 0.83, 95% CI 0.71 to 0.96; 3 studies, 3641 participants; high certainty evidence; 6-year NNTB 28) compared to usual care. Organised AF clinical services may have little to no effect on thromboembolic complications such as stroke (RR 1.14, 95% CI 0.74 to 1.77; 5 studies, 4653 participants; low certainty evidence; 6-year NNTB 588) and major cerebrovascular bleeding events (RR 1.25, 95% CI 0.79 to 1.97; 3 studies, 2964 participants; low certainty evidence; 6-year NNTB 556). None of the studies reported minor cerebrovascular events. AUTHORS' CONCLUSIONS Moderate certainty evidence shows that organisation of clinical services for AF likely results in a large reduction in all-cause mortality, but probably makes little to no difference to all-cause hospitalisation compared to usual care. Organised AF clinical services may not reduce cardiovascular mortality, but do reduce cardiovascular hospitalisation compared to usual care. However, organised AF clinical services may make little to no difference to thromboembolic complications and major cerebrovascular events. None of the studies reported minor cerebrovascular events. Due to the limited number of studies, more research is required to compare different models of care organisation, including utilisation of mHealth. Appropriately powered trials are needed to confirm these findings and robustly examine the effect on inconclusive outcomes. The findings of this review underscore the importance of the co-ordination of care underpinned by collaborative multidisciplinary approaches and augmented by virtual care.
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Affiliation(s)
- Caleb Ferguson
- Centre for Chronic & Complex Care Research, Western Sydney Local Health District, Sydney, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Fahad Shaikh
- Centre for Chronic & Complex Care Research, Western Sydney Local Health District, Sydney, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Sabine M Allida
- Centre for Chronic & Complex Care Research, Western Sydney Local Health District, Sydney, Australia
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Jeroen Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide, South Australian Health and Medical Research Institute and Royal Adelaide Hospital, Adelaide, Australia
| | - Beata V Bajorek
- Heart and Brain Program, Hunter Medical Research Institute, Newcastle, Australia
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, Australia
- Department of Pharmacy, Hunter New England Local Health District, Newcastle, Australia
| | - Andrew Donkor
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Sally C Inglis
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Ayash B, Malaeb D, Hallit S, Hosseini H. Assessing adherence to treatment guidelines and complications among atrial fibrillation patients in the United Arab Emirates. Front Cardiovasc Med 2024; 11:1359922. [PMID: 39049956 PMCID: PMC11266282 DOI: 10.3389/fcvm.2024.1359922] [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: 12/22/2023] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
Background Atrial fibrillation (AF), a potential trigger for stroke development, is considered a modifiable condition that can halt complications, decrease mortality, and prevent morbidity. The CHA₂DS₂-VASc and HAS-BLED scores are categorized as risk assessment tools used to estimate the risk of thrombosis development and assess major bleeding among atrial fibrillation patients. Objectives Our study aims to assess the adherence to post-discharge treatment recommendations according to CHA₂DS₂-VASc score risk group and evaluate the impact of CHA₂DS₂-VASc score and HAS-BLED score risk categories on death, length of hospital stay, complications, and hospital readmission among United Arab Emirates (UAE) patients. Methods This was a multicenter retrospective study conducted from November 2022 to April 2023 in the United Arab Emirates. Medical charts for AF patients were assessed for possible enrolment in the study. Results A total number of 400 patients were included with a mean age of 55 (±14.5) years. The majority were females (67.8%), and most had high CHA₂DS₂-VASc and HAS-BLED scores (60% and 57.3%, respectively). Our study showed that adherence to treatment recommendations upon discharge was 71.8%. The bivariate analysis showed that patients with a high CHA₂DS₂-VASc score had a significantly higher risk of death (p-value of 0.001), hospital readmission (p-value of 0.007), and complications (p-value of 0.044) vs. the low and moderate risk group with a p-value of <0.05. Furthermore, our findings showed that the risk of death (0.001), complications (0.057), and mean hospital stay (0.003) were significantly higher in the high HAS-BLED risk score compared to both the low- and moderate-risk categories. Hospital stay was significantly higher in CHA₂DS₂-VASc and HAS-BLED high-risk score categories compared to the low-risk score category with a p-value of <0.001. Conclusion Our study concluded that the adherence to treatment guidelines in atrial fibrillation patients was high and showed that patients received the most effective and patient-centered treatment. In addition, our study concluded that the risk of complications and mortality was higher in high-risk category patients.
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Affiliation(s)
- Bayan Ayash
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Department of Psychology, College of Humanities, Effat University, Jeddah, Saudi Arabia
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Hassan Hosseini
- UPEC-University Paris-Est, Creteil, France
- RAMSAY SANTÉ, HPPE, Champigny sur Marne, France
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Zhao Y, Wang D. Bibliometric Insights Into the Evolution of Atrial Fibrillation and Dementia Research 2002-2022. Med Sci Monit 2024; 30:e943239. [PMID: 38504433 PMCID: PMC10936108 DOI: 10.12659/msm.943239] [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: 11/19/2023] [Accepted: 01/01/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND In response to the escalating prevalence of atrial fibrillation (AF) and its potential correlation with cognitive impairment and dementia, we conducted a comprehensive bibliometric analysis to assess current research trends, contributors, and collaborative networks in this evolving interdisciplinary field. MATERIAL AND METHODS Articles published between 2002 and 2022 were extracted from the Web of Science database and carefully screened, yielding 328 publications. Two reviewers independently conducted the screening and quality appraisal. We employed sophisticated tools such as CiteSpace, VOSviewer, and Bibliometrix (R-Studio's R tool) to succinctly summarize and thoroughly analyze the publications. RESULTS A total of 328 publications, comprising 262 papers and 66 reviews, were included in the final analysis. The number of publications exhibited a consistent year-on-year increase, demonstrating an average annual growth rate of 20.57%. These publications originated from 41 countries and regions, with the highest contributions observed from the United States, United Kingdom, Italy, and China. Notably, the University of Liverpool emerged as the most prolific institution, while the most prolific author was Lip GYH from the United Kingdom. The journal with the most publications is the journal of the American Heart Association (19 articles). The most popular keywords in order were: risk and stroke (n=101), dementia (n=100), decline (n=70), prevalence (n=67), and Alzheimer's disease. CONCLUSIONS This study shows the current research status and emerging trends in atrial fibrillation's link to dementia and cognitive impairment. It highlights global growth and collaboration patterns while offering a comprehensive view of their interrelationship, pointing toward future research directions.
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Ghanbari H, Whibley D, Lehmann HI, Li Z, Kratz A, Clauw DJ, Nallamothu BK. Episodes of Atrial Fibrillation and Symptoms: A Temporal Analysis. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2023; 4:143-148. [PMID: 37850044 PMCID: PMC10577487 DOI: 10.1016/j.cvdhj.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Background Data on the relationship between symptoms and atrial fibrillation (AF) episodes are limited. Objective The objective of this study was to determine the strength of temporal association between AF episodes and symptoms. Methods This cross-sectional ambulatory assessment study was performed in a tertiary care center between June 2018 and December 2021. Patients with paroxysmal AF (1 episode of AF, burden not exceeding 95%) who used a mobile application and continuous wearable electrocardiogram monitor for 21 days were enrolled. The primary outcome was worse symptoms (symptoms above the mean score) over the study period. The association between worse symptoms and the presence of AF was evaluated for different time epochs. Multilevel mixed-effects models were used to quantify associations after accounting for confounders. Results Worse symptoms were more likely to be associated with the presence of AF episodes 15 minutes prior to the reporting of palpitations (OR, 2.8 [95% CI, 1.6-5.0]; P < .001), shortness of breath (OR, 2.2 [95% CI, 1.3-3.7]; P = .003), dizziness/lightheadedness (OR, 2.0 [95% CI, 1.0-3.7]; P = .04), and fatigue (OR, 1.7 [95% CI, 1.0-2.9]; P = .03). The correlation between the severity of symptoms and AF lessened as the time interval from AF events to symptoms increased. Conclusion There is a significant relationship between onset of AF episodes and reporting of symptoms. This association diminishes over time and varies across different symptoms. If confirmed in larger studies, these findings may inform AF interventions that target symptoms just in time prior to a clinical visit.
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Affiliation(s)
- Hamid Ghanbari
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Daniel Whibley
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - H. Immo Lehmann
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Zhi Li
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anna Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Daniel J. Clauw
- Department of Internal Medicine, Division of Rheumatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brahmajee K. Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Yamin M, Salim S, Setiati S, Pudianto AP, Zulmiyusrini P, Nasution SA, Wijaya IP, Rusdi L, Karim B, Santoso RFH, Silitonga FAH. Validity and reliability studies of the Indonesian version of Atrial Fibrillation Severity Scale (AFSS). BMC Cardiovasc Disord 2023; 23:216. [PMID: 37118699 PMCID: PMC10148504 DOI: 10.1186/s12872-023-03240-9] [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: 10/04/2022] [Accepted: 04/12/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND In the atrial fibrillation (AF) population, worsened quality of life (QOL) has been reported even before complications occur. Symptom-based questionnaires can be used to evaluate AF treatment. The Atrial Fibrillation Severity Scale (AFSS) was first developed in Canada in English, which is not the main language in Indonesia. This study aims to test the reliability and validity of the Indonesian version of the Atrial Fibrillation Severity Scale (AFSS). METHODS Translation of the AFSS from English to Indonesian was done using forward and backward translation. The final version was then validated with the Short Form-36 (SF-36) questionnaire, and a test-retest reliability study was done in a 7-14-day interval. RESULTS An Indonesian version of AFSS was achieved and deemed acceptable by a panel of researchers. This version is reliable and valid, with Cronbach's α of 0.819, Intraclass Correlation Coefficient (ICC) ranging from 0.803 to 0.975, and total score correlation ranging from 0.333 to 0.895. Pearson's analysis of AFSS and SF-36 revealed that the total AF burden domain was poorly correlated with role limitations due to emotional problems (r:0.427; p < 0.01) and pain (r:0.495; p < 0.01). The symptom severity domain was poorly correlated with physical functioning (r:-0.335; p < 0.01), role limitations due to emotional problems (r:0.499; p < 0.01), pain (r:0.458; p < 0.01), and total SF-36 score (r:-0.361; p < 0.01). Total AFSS score was moderately correlated with role limitations due to emotional problems (r:0.516; p < 0.01) and pain (r:0.538; p < 0.01). The total AFSS score was poorly correlated with the European Heart Rhythm Association (EHRA) score (r:0.315; p < 0.01). CONCLUSION The Indonesian version of AFSS has good internal and external validity with good reliability.
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Affiliation(s)
- Muhammad Yamin
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Simon Salim
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia.
| | - Siti Setiati
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Angga Pramudita Pudianto
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Putri Zulmiyusrini
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sally Aman Nasution
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Ika Prasetya Wijaya
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Lusiani Rusdi
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Birry Karim
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Raden Fidiaji Hiltono Santoso
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
| | - Friska Anggraini Helena Silitonga
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jl. Pangeran Diponegoro No.71, Central Jakarta, Jakarta, Indonesia
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Theunissen LJHJ, van de Pol JAA, van Steenbergen GJ, Cremers HP, van Veghel D, van der Voort PH, Polak PE, de Jong SFAMS, Seelig J, Smits G, Kemps HMC, Dekker LRC. The prognostic value of quality of life in atrial fibrillation on patient value. Health Qual Life Outcomes 2023; 21:33. [PMID: 37016364 PMCID: PMC10074786 DOI: 10.1186/s12955-023-02112-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/15/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND In this study, the prognostic value of AF-related quality of life (AFEQT) at baseline on Major Adverse Cardiovascular Events (MACE) and improvement of perceived symptoms (EHRA) was assessed. Furthermore, the relationship between QoL and AF-related hospitalizations was assessed. METHODS A cohort of AF-patients diagnosed between November 2014 and October 2019 in four hospitals embedded within the Netherlands Heart Network were prospectively followed for 12 months. MACE was defined as stroke, myocardial infarction, heart failure and/or mortality. Subsequently, MACE, EHRA score improvement and AF-related hospitalizations between baseline and 12 months of follow-up were recorded. RESULTS In total, 970 AF-patients were available for analysis. In analyses with patients with complete information on the confounder subset 36/687 (5.2%) AF-patients developed MACE, 190/432 (44.0%) improved in EHRA score and 189/510(37.1%) were hospitalized during 12 months of follow-up. Patients with a low AFEQT score at baseline more often developed MACE (OR(95%CI): 2.42(1.16-5.06)), more often improved in EHRA score (OR(95%CI): 4.55(2.45-8.44) and were more often hospitalized (OR(95%CI): 4.04(2.22-7.01)) during 12 months post diagnosis, compared to patients with a high AFEQT score at baseline. CONCLUSIONS AF-patients with a lower quality of life at diagnosis more often develop MACE, more often improve on their symptoms and also were more often hospitalized, compared to AF-patients with a higher quality of life. This study highlights that the integration of patient-reported outcomes, such as quality of life, has the potential to be used as a prognostic indicator of the expected disease course for AF.
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Affiliation(s)
- Luc J H J Theunissen
- Máxima Medical Center, Veldhoven, The Netherlands
- Netherlands Heart Network, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands
- Department of Electrical Engineering (SPS group), Eindhoven University of Technology (TUe), Eindhoven, The Netherlands
| | - Jeroen A A van de Pol
- Netherlands Heart Network, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands.
- Department of Electrical Engineering (SPS group), Eindhoven University of Technology (TUe), Eindhoven, The Netherlands.
| | | | | | - Dennis van Veghel
- Netherlands Heart Network, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands
- Catharina hospital Eindhoven, Eindhoven, The Netherlands
| | - Pepijn H van der Voort
- Netherlands Heart Network, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands
- Catharina hospital Eindhoven, Eindhoven, The Netherlands
| | - Peter E Polak
- Netherlands Heart Network, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands
- Anna hospital, Geldrop, The Netherlands
| | - Sylvie F A M S de Jong
- Netherlands Heart Network, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands
- Elkerliek hospital, Helmond, The Netherlands
| | - Jaap Seelig
- Rijnstate, Arnhem, The Netherlands
- Cardiovascular research institute, Maastricht University, Maastricht, The Netherlands
| | - Geert Smits
- GP Organization POZOB, Veldhoven, The Netherlands
| | - Hareld M C Kemps
- Máxima Medical Center, Veldhoven, The Netherlands
- Netherlands Heart Network, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands
- Department of Industrial Design, Eindhoven University of Technology (TUe), Eindhoven, The Netherlands
| | - Lukas R C Dekker
- Netherlands Heart Network, Michelangelolaan 2, Eindhoven, 5623 EJ, The Netherlands
- Catharina hospital Eindhoven, Eindhoven, The Netherlands
- Department of Electrical Engineering (SPS group), Eindhoven University of Technology (TUe), Eindhoven, The Netherlands
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Rashid S, Noor TA, Saeed H, Ali AS, Meheshwari G, Mehmood A, Fatima L, Zaidi SMJ, Malik J, Mehmoodi A, Hayat A. Association of gut microbiome dysbiosis with the progression of atrial fibrillation: A systematic review. Ann Noninvasive Electrocardiol 2023:e13059. [PMID: 36940225 DOI: 10.1111/anec.13059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023] Open
Abstract
OBJECTIVE Many clinical and preclinical studies have implicated an association between atrial fibrillation (AF) and its progression to imbalances in the gut microbiome composition. The gut microbiome is a diverse and complex ecosystem containing billions of microorganisms that produce biologically active metabolites influencing the host disease development. METHODS For this review, a literature search was conducted using digital databases to systematically identify the studies reporting the association of gut microbiota with AF progression. RESULTS In a total of 14 studies, 2479 patients were recruited for the final analysis. More than half (n = 8) of the studies reported alterations in alpha diversity in atrial fibrillation. As for the beta diversity, 10 studies showed significant alterations. Almost all studies that assessed gut microbiota alterations reported major taxa associated with atrial fibrillation. Most studies focused on short-chain fatty acids (SCFAs), whereas three studies evaluated TMAO levels in the blood, which is the breakdown product of dietary l-carnitine, choline, and lecithin. Moreover, an independent cohort study assessed the relationship between phenylacetylglutamine (PAGIn) and AF. CONCLUSION Intestinal dysbiosis is a modifiable risk factor that might provide newer treatment strategies for AF prevention. Well-designed research and prospective randomized interventional studies are required to target the gut dysbiotic mechanisms and determine the gut dysbiotic-AF relationship.
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Affiliation(s)
- Sarim Rashid
- Department of General Surgery, Eash Lancashire NHS Hospital, Burnley, UK
| | | | - Hamayle Saeed
- Department of Medicine, Fatima Memorial Hospital, Lahore, Pakistan
| | - Asma Sabir Ali
- Department of Dermatology, KRL Hospital, Islamabad, Pakistan
| | - Govinda Meheshwari
- Department of Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Asad Mehmood
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Laveeza Fatima
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Syed Muhammad Jawad Zaidi
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan.,Department of Cardiovascular Research, Cardiovascular Analytics Group, Canterbury, UK
| | - Jahanzeb Malik
- Department of Cardiovascular Research, Cardiovascular Analytics Group, Canterbury, UK.,Department of Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
| | - Amin Mehmoodi
- Department of Medicine, Ibn e Seena Hospital, Kabul, Afghanistan
| | - Azmat Hayat
- Department of Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
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Gibbs A, Fitzpatrick M, Lilburn M, Easlea H, Francey J, Funston R, Diven J, Murray S, Mitchell OGJ, Condon A, Mitchell ARJ, Sanchez B, Steinhaus D. A universal, high-performance ECG signal processing engine to reduce clinical burden. Ann Noninvasive Electrocardiol 2022; 27:e12993. [PMID: 35904510 PMCID: PMC9484027 DOI: 10.1111/anec.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/07/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Electrocardiogram (ECG) signal conditioning is a vital step in the ECG signal processing chain that ensures effective noise removal and accurate feature extraction. OBJECTIVE This study evaluates the performance of the FDA 510 (k) cleared HeartKey Signal Conditioning and QRS peak detection algorithms on a range of annotated public and proprietary ECG databases (HeartKey is a UK Registered Trademark of B-Secur Ltd). METHODS Seven hundred fifty-one raw ECG files from a broad range of use cases were individually passed through the HeartKey signal processing engine. The algorithms include several advanced filtering steps to enable significant noise removal and accurate identification of the QRS complex. QRS detection statistics were generated against the annotated ECG files. RESULTS HeartKey displayed robust performance across 14 ECG databases (seven public, seven proprietary), covering a range of healthy and unhealthy patient data, wet and dry electrode types, various lead configurations, hardware sources, and stationary/ambulatory recordings from clinical and non-clinical settings. Over the NSR, MIT-BIH, AHA, and MIT-AF public databases, average QRS Se and PPV values of 98.90% and 99.08% were achieved. Adaptable performance (Se 93.26%, PPV 90.53%) was similarly observed on the challenging NST database. Crucially, HeartKey's performance effectively translated to the dry electrode space, with an average QRS Se of 99.22% and PPV of 99.00% observed over eight dry electrode databases representing various use cases, including two challenging motion-based collection protocols. CONCLUSION HeartKey demonstrated robust signal conditioning and QRS detection performance across the broad range of tested ECG signals. It should be emphasized that in no way have the algorithms been altered or trained to optimize performance on a given database, meaning that HeartKey is potentially a universal solution capable of maintaining a high level of performance across a broad range of clinical and everyday use cases.
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Affiliation(s)
- Austin Gibbs
- The Allan LabJersey General HospitalSaint HelierJersey
| | | | | | | | | | | | | | | | | | | | | | - Benjamin Sanchez
- Department of Electrical & Computer EngineeringUniversity of UtahSalt Lake CityUtahUSA
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Gao X, Liu K, Zhao X, Lv X, Wu X, Ren C, Chen Q, Li Y. Global research trends in catheter ablation and surgical treatment of atrial fibrillation: A bibliometric analysis and science mapping. Front Surg 2022; 9:1048454. [PMID: 36684348 PMCID: PMC9852516 DOI: 10.3389/fsurg.2022.1048454] [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: 09/19/2022] [Accepted: 11/02/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction To evaluate the global research results of the catheter ablation and surgical treatment of atrial fibrillation in the past 40 years by bibliometrics, and to explore the hotspots and prospects for future development. Methods Relevant literatures were selected from the Web of Science Core Collection. VOSviewer 1.6.17, SciMAT 1.1.04, and CiteSpace 5.8.R1 were used to analyze the data objectively, deeply and comprehensively. Results As of July 14, 2021, 11,437 studies for the catheter ablation and surgical treatment of atrial fibrillation have been identified from 1980 to 2021. The Journal of Cardiovascular Electrophysiology and Circulation respectively ranked first in terms of the number of publications and the number of co-citations. A total of 6,631 institutions from 90 countries participated in the study, with USA leading the way with 3,789 documents. Cryoablation, atrial fibrosis, substrate modification, minimally invasive and access surgery will still be the research focus and frontier in the next few years. Conclusions The publication information for the catheter ablation and surgical treatment of atrial fibrillation were reviewed, including country, institution, author, journal publications, and so on. Developed countries had the advantage in this research areas, and cooperation with low-income countries should be improved. The former research hotspots in the field of catheter ablation and surgical treatment of atrial fibrillation were analyzed, and the future research direction was predicted.
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Affiliation(s)
- Xiang Gao
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China.,Department of Cardiovascular Surgery, Gansu Provincial Hospital, Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
| | - Kai Liu
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Xinke Zhao
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Xinfang Lv
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Xue Wu
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Chunzhen Ren
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Qilin Chen
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yingdong Li
- Department of Cardiovascular Surgery, Gansu Provincial Hospital, Gansu University of Chinese Medicine, Lanzhou, China
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10
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Masterson Creber R, Turchioe MR. Returning Cardiac Rhythm Data to Patients: Opportunities and Challenges. Card Electrophysiol Clin 2021; 13:555-567. [PMID: 34330381 PMCID: PMC8328196 DOI: 10.1016/j.ccep.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spurred by federal legislation, professional organizations, and patients themselves, patient access to data from electronic cardiac devices is increasingly transparent. Patients can collect data through consumer devices and access data traditionally shared only with health care providers. These data may improve screening, self-management, and shared decision-making for cardiac arrhythmias, but challenges remain, including patient comprehension, communication with providers, and sustained engagement. Ways to address these challenges include leveraging visualizations that support comprehension, involving patients in designing and developing patient-facing digital tools, and establishing clear practices and goals for data exchange with health care providers.
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Affiliation(s)
- Ruth Masterson Creber
- Division of Health Informatics, Weill Cornell Medicine, 425 E 61st St, Floor 3, New York, NY 10065, USA.
| | - Meghan Reading Turchioe
- Division of Health Informatics, Weill Cornell Medicine, 425 E 61st St, Floor 3, New York, NY 10065, USA
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11
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Lee J, Turchioe MR, Creber RM, Biviano A, Hickey K, Bakken S. Phenotypes of engagement with mobile health technology for heart rhythm monitoring. JAMIA Open 2021; 4:ooab043. [PMID: 34131638 PMCID: PMC8200132 DOI: 10.1093/jamiaopen/ooab043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/08/2021] [Accepted: 05/07/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives Guided by the concept of digital phenotypes, the objective of this study was to identify engagement phenotypes among individuals with atrial fibrillation (AF) using mobile health (mHealth) technology for 6 months. Materials and Methods We conducted a secondary analysis of mHealth data, surveys, and clinical records collected by participants using mHealth in a clinical trial. Patterns of participants’ weekly use over 6 months were analyzed to identify engagement phenotypes via latent growth mixture model (LGMM). Multinomial logistic regression models were fitted to compute the effects of predictors on LGMM classes. Results One hundred twenty-eight participants (mean age 61.9 years, 75.8% male) were included in the analysis. Application of LGMM identified 4 distinct engagement phenotypes: “High-High,” “Moderate-Moderate,” “High-Low,” and “Moderate-Low.” In multinomial models, older age, less frequent afternoon mHealth use, shorter intervals between mHealth use, more AF episodes measured directly with mHealth, and lower left ventricular ejection fraction were more strongly associated with the High-High phenotype compared to the Moderate-Low phenotype (reference). Older age, more palpitations, and a history of stroke or transient ischemic attack were more strongly associated with the Moderate-Moderate phenotype compared to the reference. Discussion Engagement phenotypes provide a nuanced characterization of how individuals engage with mHealth over time, and which individuals are more likely to be highly engaged users. Conclusion This study demonstrates that engagement phenotypes are valuable in understanding and possibly intervening upon engagement within a population, and also suggests that engagement is an important variable to be considered in digital phenotyping work more broadly.
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Affiliation(s)
- Jihui Lee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | | | - Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Angelo Biviano
- Department of Medicine-Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Kathleen Hickey
- Columbia University School of Nursing, New York, New York, USA
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, New York, USA.,Department of Biomedical Informatics, Columbia University, New York, New York, USA
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12
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Multimorbidity, physical frailty, and self-rated health in older patients with atrial fibrillation. BMC Geriatr 2020; 20:343. [PMID: 32917137 PMCID: PMC7488548 DOI: 10.1186/s12877-020-01755-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Holistic care models emphasize management of comorbid conditions to improve patient-reported outcomes in treatment of atrial fibrillation (AF). We investigated relations between multimorbidity, physical frailty, and self-rated health (SRH) among older adults with AF. METHODS Patients (n = 1235) with AF aged 65 years and older were recruited from five medical centers in Massachusetts and Georgia between 2015 and 2018. Ten previously diagnosed cardiometabolic and 8 non-cardiometabolic conditions were assessed from medical records. Physical Frailty was assessed with the Cardiovascular Health Study frailty scale. SRH was categorized as either "excellent/very good", "good", and "fair/poor". Separate multivariable ordinal logistic models were used to examine the associations between multimorbidity and SRH, physical frailty and SRH, and multimorbidity and physical frailty. RESULTS Overall, 16% of participants rated their health as fair/poor and 14% were frail. Hypertension (90%), dyslipidemia (80%), and heart failure (37%) were the most prevalent cardiometabolic conditions. Arthritis (51%), anemia (31%), and cancer (30%), the most common non-cardiometabolic diseases. After multivariable adjustment, patients with higher multimorbidity were more likely to report poorer health status (Odds Ratio (OR): 2.15 [95% CI: 1.53-3.03], ≥ 8 vs 1-4; OR: 1.37 [95% CI: 1.02-1.83], 5-7 vs 1-4), as did those with more prevalent cardiometabolic and non-cardiometabolic conditions. Patients who were pre-frail (OR: 1.73 [95% CI: 1.30-2.30]) or frail (OR: 6.81 [95% CI: 4.34-10.68]) reported poorer health status. Higher multimorbidity was associated with worse frailty status. CONCLUSIONS Multimorbidity and physical frailty were common and related to SRH. Our findings suggest that holistic management approaches may influence SRH among older patients with AF.
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13
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Ladwig KH, Goette A, Atasoy S, Johar H. Psychological aspects of atrial fibrillation: A systematic narrative review : Impact on incidence, cognition, prognosis, and symptom perception. Curr Cardiol Rep 2020; 22:137. [PMID: 32910300 PMCID: PMC7496063 DOI: 10.1007/s11886-020-01396-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF THE REVIEW Atrial fibrillation (AF) is the most frequent arrhythmia in the general population. This review aims to provide a comprehensive overview of the psychological aspects of AF, compiling evidence from epidemiological, clinical, and basic research sources. RECENT FINDINGS Findings from large-scale population-based and clinical longitudinal studies reveal an association between negative affectivity (e.g. depression) and the incidence and clinical prognosis of AF. Studies investigating the impact of work stress parameters on AF onset show conflicting results. Researchers have reported the impact of AF on cognitive decline and on health-related quality of life, and have highlighted the role of interoceptive cues in the development of AF symptom burden and gender differences in psychological covariates of AF. Among biological pathways linking psychosocial factors to AF, research on autonomic regulation has yielded the most evidence so far, showing that the onset of AF is associated with simultaneous sympatho-vagal activation rather than an increase in vagal or sympathetic drive alone. Thus, modulation of the autonomic nervous system is likely to be a promising strategy for protecting the myocardium from pro-arrhythmic autonomic influences. In total, the findings show that AF is embedded as a disease condition in a psycho-societal context and is not an isolated medical problem per se. A broader perspective than a focus on the electrophysiology alone is urgently needed.
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Affiliation(s)
- Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM), Langerstr. 3, 81675 Munich, Germany
- Institute of Epidemiology, Mental Health Research Unit, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
| | - Andreas Goette
- St. Vincenz-Krankenhaus GmbH, Medizinischen Klinik II, Paderborn, Germany
- Working Group on Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Seryan Atasoy
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München (TUM), Langerstr. 3, 81675 Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Marburg, Germany
| | - Hamimatunnisa Johar
- Institute of Epidemiology, Mental Health Research Unit, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Gießen and Marburg, Marburg, Germany
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14
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Sławuta A, Jacek P, Mazur G, Jankowska-Polańska B. Quality of Life and Frailty Syndrome in Patients with Atrial Fibrillation. Clin Interv Aging 2020; 15:783-795. [PMID: 32764894 PMCID: PMC7359853 DOI: 10.2147/cia.s248170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction Atrial fibrillation (AF) and frailty syndrome (FS) are a part of the aging process. Both are still of great importance in the assessment of quality of life (QoL). There is definitely a lack of research clarifying the association between FS and QoL in AF patients. Objective The aim of this study was to evaluate the influence of FS on QoL in AF patients. Materials and Methods The retrospective and observational study included 158 inpatients with mean age 69.8±7.1 years, treated for AF in the cardiac department from 1 April 2019 to 31 June 2019. The following instruments were used: the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA) and the Edmonton Frail Scale (EFS). Results The mean level of frailty in the study group was 8.5±5.0. In 25.9% of patients, the level of frailty was mild, in 10.1% moderate, and in 17.1% severe. Patients were divided into two groups based on their frailty status. In comparative analysis of the QoL, there were significant differences between the groups: the frail group had more intense symptoms of arrhythmia than the non-frail group (14.9±4.1 vs 11.9±4.9; p<0.001). In the analysis of the total score impact of arrhythmia on QoL, the frail group had a significantly higher score than the non-frail group (23.5±5.2 vs 14.5±5.5), which confirmed the stronger negative impact of arrhythmia on QoL. In the regression coefficient analysis, the independent predictor of symptom severity and QoL was FS. However, we observed a negative impact of diabetes, which increased the impact of arrhythmia on QoL, and physical activity, which improved QoL and decreased the impact of symptoms on everyday life. Conclusion Patients in the frail group have worse QoL and higher impact of arrhythmia on QoL in comparison to patients in the non-frail group. Frailty is an independent predictor of higher intensity of symptoms of arrhythmia and worse QoL. Diabetes and physical activity are predictors of QoL for patients with AF.
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Affiliation(s)
- Agnieszka Sławuta
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Polański Jacek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Wrocław, Poland
| | - Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wrocław, Poland
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15
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Kwon S, Hong J, Choi EK, Lee B, Baik C, Lee E, Jeong ER, Koo BK, Oh S, Yi Y. Detection of Atrial Fibrillation Using a Ring-Type Wearable Device (CardioTracker) and Deep Learning Analysis of Photoplethysmography Signals: Prospective Observational Proof-of-Concept Study. J Med Internet Res 2020; 22:e16443. [PMID: 32348254 PMCID: PMC7273241 DOI: 10.2196/16443] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/24/2020] [Accepted: 03/21/2020] [Indexed: 12/23/2022] Open
Abstract
Background Continuous photoplethysmography (PPG) monitoring with a wearable device may aid the early detection of atrial fibrillation (AF). Objective We aimed to evaluate the diagnostic performance of a ring-type wearable device (CardioTracker, CART), which can detect AF using deep learning analysis of PPG signals. Methods Patients with persistent AF who underwent cardioversion were recruited prospectively. We recorded PPG signals at the finger with CART and a conventional pulse oximeter before and after cardioversion over a period of 15 min (each instrument). Cardiologists validated the PPG rhythms with simultaneous single-lead electrocardiography. The PPG data were transmitted to a smartphone wirelessly and analyzed with a deep learning algorithm. We also validated the deep learning algorithm in 20 healthy subjects with sinus rhythm (SR). Results In 100 study participants, CART generated a total of 13,038 30-s PPG samples (5850 for SR and 7188 for AF). Using the deep learning algorithm, the diagnostic accuracy, sensitivity, specificity, positive-predictive value, and negative-predictive value were 96.9%, 99.0%, 94.3%, 95.6%, and 98.7%, respectively. Although the diagnostic accuracy decreased with shorter sample lengths, the accuracy was maintained at 94.7% with 10-s measurements. For SR, the specificity decreased with higher variability of peak-to-peak intervals. However, for AF, CART maintained consistent sensitivity regardless of variability. Pulse rates had a lower impact on sensitivity than on specificity. The performance of CART was comparable to that of the conventional device when using a proper threshold. External validation showed that 94.99% (16,529/17,400) of the PPG samples from the control group were correctly identified with SR. Conclusions A ring-type wearable device with deep learning analysis of PPG signals could accurately diagnose AF without relying on electrocardiography. With this device, continuous monitoring for AF may be promising in high-risk populations. Trial Registration ClinicalTrials.gov NCT04023188; https://clinicaltrials.gov/ct2/show/NCT04023188
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Affiliation(s)
- Soonil Kwon
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Joonki Hong
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Eue-Keun Choi
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | | | - Euijae Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Eui-Rim Jeong
- Department of Information and Communication Engineering, Hanbat National University, Daejeon, Republic of Korea
| | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Yung Yi
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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16
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Turchioe MR, Jimenez V, Isaac S, Alshalabi M, Slotwiner D, Creber RM. Review of mobile applications for the detection and management of atrial fibrillation. Heart Rhythm O2 2020; 1:35-43. [PMID: 32656542 PMCID: PMC7351352 DOI: 10.1016/j.hroo.2020.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Free mobile applications (apps) that use photoplethysmography (PPG) waveforms may extend atrial fibrillation (AF) detection to underserved populations, but they have not been rigorously evaluated. OBJECTIVE The purpose of this study was to systematically review and evaluate the quality, functionality, and adherence to self-management behaviors of existing mobile apps for AF. METHODS We systematically searched 3 app stores for apps that were free, available in English, and intended for use by patients to detect and manage AF. A minimum of 2 reviewers evaluated (1) app quality, using the Mobile Application Rating Scale (MARS); (2) functionality using published criteria; and (3) features that support 4 self-management behaviors (including PPG waveform monitoring) identified using evidence-based guidelines. Interrater reliability between the reviewers was calculated. RESULTS Of 12 included apps, 5 (42%) scored above average for quality (MARS score ≥3.0). App quality was highest for their ease of use, navigation, layout, and visual appeal (eg, functionality and aesthetics) and lowest for their behavioral change support and subjective impressions of quality. The most common app functionalities were capturing and graphically displaying user-entered data (n = 9 [75%]). Nearly all apps (n = 11 [92%]) supported PPG waveform monitoring, but only 2 (17%) supported all 4 self-management behaviors. Interrater reliability was high (0.75-0.83). CONCLUSION The reviewed apps had wide variability in quality, functionality, and adherence to self-management behaviors. Given the accessibility of these apps to underserved populations and the tremendous potential they hold for improving AF detection and management, high priority should be given to improving app quality and functionality.
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Affiliation(s)
- Meghan Reading Turchioe
- Address reprint requests and correspondence: Dr Meghan Reading Turchioe, Department of Population Health Sciences, Division of Health Informatics, Weill Cornell Medicine, 425 East 61st Street, Suite 301, New York, NY 10065.
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17
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Allan KS, Aves T, Henry S, Banfield L, Victor JC, Dorian P, Healey JS, Andrade JG, Carroll SL, McGillion MH. Health-Related Quality of Life in Patients With Atrial Fibrillation Treated With Catheter Ablation or Antiarrhythmic Drug Therapy: A Systematic Review and Meta-analysis. CJC Open 2020; 2:286-295. [PMID: 32695978 PMCID: PMC7365832 DOI: 10.1016/j.cjco.2020.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023] Open
Abstract
Background Catheter ablation (CA) is performed in patients with atrial fibrillation (AF) to reduce symptoms and improve health-related quality of life (HRQL). Methods This systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated CA of any energy modality compared with antiarrhythmic drugs (AADs) using inverse-variance random-effects models. We searched for RCTs reporting HRQL and AF-related symptoms at 3, 6, 12, 24, 48, and 60 months after treatment as well as the number of repeat ablations. Results Of 15,878 records, we included 13 RCTs of CA vs AADs for the analyses of HRQL, 7 RCTs for the analyses of AF-related symptoms, and 13 RCTs for the number of repeat ablations. For the HRQL analyses at 3 months, there were significant increases in both the Physical Component Summary score (3 months' standardized mean difference = 0.58 [0.39-0.78]; P < 0.00001, I 2 = 6%, 3 trials, n = 443) and the Mental Component Summary score (3 months' standardized mean difference = 0.57 [0.37-0.77]; P < 0.00001, I 2 = 0%, 3 trials, n = 443), favouring CA over AADs. These differences were sustained at 12 months but not >24 months after randomization. Similar results were seen for AF-related symptoms. The number of repeat ablations and success rates after procedure varied considerably across trials. Conclusions Evidence from few trials suggests that CA improves physical and mental health and AF-related symptoms in the short term, but these benefits decrease with time. More trials, reporting both HRQL and AF-related symptoms, at consistent time points are needed to assess the effectiveness of CA for the treatment of AF.
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Affiliation(s)
- Katherine S. Allan
- Division of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Corresponding author: Dr Katherine S. Allan, St. Michael’s Hospital, 193 Yonge St, Suite 3-007, Toronto, Ontario M5B 1M8, Canada. Tel: +1-416-864-6060, ×76347.
| | - Theresa Aves
- Division of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - J. Charles Victor
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Division of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
- Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jason G. Andrade
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada
| | - Sandra L. Carroll
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Michael H. McGillion
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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