Usefulness of a Lifestyle Intervention in Patients With Cardiovascular Disease

Strengthening primary health care in Europe with digital solutions

This article provides an in-depth analysis of digital transformation in European primary healthcare (PHC). It assesses the impact of digital technology on healthcare delivery and management, highlighting variations in digital maturity across Europe. It emphasizes the significance of digital tools, especially during the COVID-19 pandemic, in enhancing accessibility and efficiency in healthcare. It discusses the integration of telehealth, remote monitoring, and e-health solutions, showcasing their role in patient empowerment and proactive care. Examples are included from various countries, such as Greece's ePrescription system, Lithuania's adoption of remote consultations, Spain's use of risk stratification solutions, and the Netherlands' advanced use of telemonitoring solutions, to illustrate the diverse implementation of digital solutions in PHC. The article offers insights into the challenges and opportunities of embedding digital technologies into a multidisciplinary healthcare framework, pointing towards future directions for PHC in Europe.

Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review

BACKGROUND

Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness.

OBJECTIVE

This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns.

METHODS

In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on.

RESULTS

To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area.

CONCLUSIONS

Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.

RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Evaluation of the Use of Activity Trackers in the Clinical Care of Adults Diagnosed With a Chronic Disease: Integrative Systematic Review

BACKGROUND

Chronic diseases are a leading cause of adult mortality, accounting for 41 million deaths globally each year. Low levels of physical activity and sedentary behavior are major risk factors for adults to develop a chronic disease. Physical activity interventions can help support patients in clinical care to be more active. Commercial activity trackers that can measure daily steps, physical activity intensity, sedentary behavior, and distance moved are being more frequently used within health-related interventions. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a planning and evaluation approach to explore the reach, effectiveness, adoption, implementation, and maintenance of interventions.

OBJECTIVE

The objective of this study is to conduct an integrative systematic review and report the 5 main RE-AIM dimensions in interventions that used activity trackers in clinical care to improve physical activity or reduce sedentary behavior in adults diagnosed with chronic diseases.

METHODS

A search strategy and study protocol were developed and registered on the PROSPERO platform. Inclusion criteria included adults (18 years and older) diagnosed with a chronic disease and have used an activity tracker within their clinical care. Searches of 10 databases and gray literature were conducted, and qualitative, quantitative, and mixed methods studies were included. Screening was undertaken by more than 1 researcher to reduce the risk of bias. After screening, the final studies were analyzed using a RE-AIM framework data extraction evaluation tool. This tool assisted in identifying the 28 RE-AIM indicators within the studies and linked them to the 5 main RE-AIM dimensions.

RESULTS

The initial search identified 4585 potential studies. After a title and abstract review followed by full-text screening, 15 studies were identified for data extraction. The analysis of the extracted data found that the RE-AIM dimensions of adoption (n=1, 7% of studies) and maintenance (n=2, 13% of studies) were underreported. The use of qualitative thematic analysis to understand the individual RE-AIM dimensions was also underreported and only used in 3 of the studies. Two studies used qualitative analysis to explore the effectiveness of the project, while 1 study used thematic analysis to understand the implementation of an intervention.

CONCLUSIONS

Further research is required in the use of activity trackers to support patients to lead a more active lifestyle. Such studies should consider using the RE-AIM framework at the planning stage with a greater focus on the dimensions of adoption and maintenance and using qualitative methods to understand the main RE-AIM dimensions within their design. These results should form the basis for establishing long-term interventions in clinical care.

TRIAL REGISTRATION

PROSPERO CRD42022319635; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319635.

Does anxiety cause angina recurrence after percutaneous coronary intervention in patients with STEMI?

Background

Statistics show that approximately 70% of patients with acute ST-segment elevation myocardial infarction (STEMI) experience relief from chest pain symptoms within 48 h post-percutaneous coronary intervention (PCI). However, over 30% of these patients still suffer from angina post-PCI during their hospital stay and after discharge. Although the interrelation between cardiovascular diseases and psychological states, notably anxiety and stress, has been extensively studied and acknowledged, the specific influence of anxiety disorders on post-PCI clinical outcomes for STEMI patients, especially the recurrence of angina, remains undefined.

Methods

This study included a total of 324 STEMI patients who underwent PCI treatment due to chest pain in our hospital. Baseline and surgical data for all patients were collected. During their hospital stay, patients' emotional states were assessed using the Hamilton Anxiety Scale, while angina was evaluated using the Seattle Angina Questionnaire. All patients were followed up for 6 months post-discharge to gather clinical data and outcomes, analyzing whether anxiety disorders would affect the recurrence of angina post-PCI in STEMI patients.

Results

Out of the 324 patients, 82 experienced recurrent angina symptoms within 6 months post-PCI discharge. Compared to the non-recurrence group, the recurrence group showed statistically significant differences in anxiety levels. Other differing factors included the spouse's health status, cardiac Killip classification, severity of coronary lesions, and the state of the coronary microcirculation. After utilizing propensity score matching to eliminate inherent biases between the two groups at a 1:1 ratio, the COX regression analysis indicated that a patient's anxiety status is a risk factor for the occurrence of angina post-PCI in STEMI patients (HR = 2.094, 95% CI = 1.248-3.514, P = 0.005).

Conclusion

Anxiety is a significant factor for short-term recurrence of angina post-PCI in STEMI patients. This further confirms the crucial impact of mental health on cardiovascular wellness.

Artificial Intelligence-Based Methods for Precision Cardiovascular Medicine

Precision medicine has the potential to revolutionize the way cardiovascular diseases are diagnosed, predicted, and treated by tailoring treatment strategies to the individual characteristics of each patient. Artificial intelligence (AI) has recently emerged as a promising tool for improving the accuracy and efficiency of precision cardiovascular medicine. In this scoping review, we aimed to identify and summarize the current state of the literature on the use of AI in precision cardiovascular medicine. A comprehensive search of electronic databases, including Scopes, Google Scholar, and PubMed, was conducted to identify relevant studies. After applying inclusion and exclusion criteria, a total of 28 studies were included in the review. We found that AI is being increasingly applied in various areas of cardiovascular medicine, including the diagnosis, prognosis of cardiovascular diseases, risk prediction and stratification, and treatment planning. As a result, most of these studies focused on prediction (50%), followed by diagnosis (21%), phenotyping (14%), and risk stratification (14%). A variety of machine learning models were utilized in these studies, with logistic regression being the most used (36%), followed by random forest (32%), support vector machine (25%), and deep learning models such as neural networks (18%). Other models, such as hierarchical clustering (11%), Cox regression (11%), and natural language processing (4%), were also utilized. The data sources used in these studies included electronic health records (79%), imaging data (43%), and omics data (4%). We found that AI is being increasingly applied in various areas of cardiovascular medicine, including the diagnosis, prognosis of cardiovascular diseases, risk prediction and stratification, and treatment planning. The results of the review showed that AI has the potential to improve the performance of cardiovascular disease diagnosis and prognosis, as well as to identify individuals at high risk of developing cardiovascular diseases. However, further research is needed to fully evaluate the clinical utility and effectiveness of AI-based approaches in precision cardiovascular medicine. Overall, our review provided a comprehensive overview of the current state of knowledge in the field of AI-based methods for precision cardiovascular medicine and offered new insights for researchers interested in this research area.

Impact of modifiable risk factors on prediction of 10-year cardiovascular disease utilizing framingham risk score in Southwest Iran

BACKGROUND

This cohort study was conducted to examine the association between modifiable risk factors, including hypertension, smoking, physical activity, diabetes, cholesterol, and high-density lipoprotein with Framingham risk score in the prediction of 10-year-risk of cardiovascular diseases (CVD) between men and women in an Arab community of Southwest Iran, Hoveyzeh.

MATERIALS AND METHODS

A total of 8,526 people aged 35-70 participated in this cohort study. Framingham was used to estimate the 10-year risk of CVD. Also, the linear regression models were used to assess the relationship between modifiable risk factors and the 10-year risk of CVD. Finally, the area under the receiver operating characteristic curve (AUC) was used to measure the ability of modifiable risk factors to predict the 10-year risk of CVD.

RESULTS

Our results of linear regression models showed that hypertension, smoking, PA, diabetes, cholesterol, and HDL were independently associated with the CVD risk in men and women. Also, AUC analysis showed that hypertension and diabetes have the largest AUC in men 0.841; 0.778 and in women 0.776; 0.715, respectively. However, physical activity had the highest AUC just in women 0.717.

CONCLUSION

Hypertension and diabetes in both gender and physical activity in women are the most important determinant for the prediction of CVD risk in Hoveyzeh. Our cohort study may be useful for adopting strategies to reduce CVD progression through lifestyle changes.

Impact of wearable device-based interventions with feedback for increasing daily walking activity and physical capacities in cardiovascular patients: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To systematically review randomised controlled trials (RCTs) using a wearable physical activity monitoring device as an intervention to increase daily walking activity and improve physical capacities in patients with cardiovascular disease (CVD).

DESIGN

Systematic review and meta-analysis of RCTs.

DATA SOURCES

PubMed, Embase and Web of Science from inception to June 2022.

ELIGIBILITY CRITERIA

Randomised controlled studies including patients with CVD over 18 years of age at the end of a cardiac rehabilitation programme comparing an intervention group using a wearable physical activity monitoring device with feedback with usual care or with a control group receiving no feedback on their physical activity and reporting a change in the daily number of steps and/or a change in the distance covered in the 6-minute walk test (6-MWT) or a change in peak oxygen uptake (V̇O2_peak) as endpoints.

RESULTS

Sixteen RCTs were included. The intervention of wearing a physical activity monitoring device with feedback significantly improved daily number of steps compared with controls (standardised mean difference (SMD) 0.85; 95% CI (0.42; 1.27); p<0.01). The effect was greater when the duration of the intervention was less than 3 months (SMD 1.0; 95% CI (0.18; 1.82); p<0.01) than when the duration of the intervention was 3 months or longer (SMD 0.71; 95% CI (0.27; 1.16); p<0.01), but no significant interaction was found between subgroups (p=0.55). 6-MWT distance and V̇O2_peak showed only small effects (SMD 0.34; 95% CI (-0.11; 0.80); p=0.02 and SMD 0.54; 95% CI (0.03; 1.03); p=0.07, respectively).

CONCLUSION

The use of wearable physical activity monitoring devices appears to help patients with CVD to increase their daily walking activity and thus their physical activity, particularly in the short term.

PROSPERO REGISTRATION NUMBER

CRD42022300423.

Exploring the Role of Wearable Electronic Medical Devices in Improving Cardiovascular Risk Factors and Outcomes Among Adults: A Systematic Review

There is a developing trend of using wearable electronic devices as health aides, spurred on by telecommunication companies as fitness devices and marketed as such. They have been shown to count steps, pulse, and record arrhythmias, doubling as communication devices and prompting healthcare providers in some instances. We sought to determine if there was a direct correlation between device use and increased physical activity as recommended by the World Health Organization, or if this physical activity increase was only marginal at best. In addition, we sought to investigate if there were additional benefits to using these devices besides increased self-awareness of health. This systematic review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Keywords for searching articles centered around cardiovascular disease, wearable electronic devices, and their synonyms. Most of the data were obtained from PubMed, although other contributing databases were used, including ResearchGate, Science.gov, ScienceDirect, and PubMed Medical Subject Headings database. Only full-text articles were used. We identified 62 articles that met our search criteria but narrowed them down to 19 following qualitative assessment. Increased physical activity was found to be the one parameter that stood out by way of benefit from the device. Other findings, such as reduced waist circumference, obesity, glycated hemoglobin, and lipid levels, shared mixed results. At this time, we do not have a definition of what duration of device use is deemed standard for health. We have no consensus on which devices are superior health-wise. Our study, however, indicates that these devices, used with adequate health professional supervision, have a role to play in motivation and increased physical activity, enough to cause impactful gains in cardiovascular health.

Evaluation of physical health status beyond daily step count using a wearable activity sensor

Physical health status defines an individual's ability to perform normal activities of daily living and is usually assessed in clinical settings by questionnaires and/or by validated tests, e.g. timed walk tests. These measurements have relatively low information content and are usually limited in frequency. Wearable sensors, such as activity monitors, enable remote measurement of parameters associated with physical activity but have not been widely explored beyond measurement of daily step count. Here we report on results from a cohort of 22 individuals with Pulmonary Arterial Hypertension (PAH) who were provided with a Fitbit activity monitor (Fitbit Charge HR^®) between two clinic visits (18.4 ± 12.2 weeks). At each clinical visit, a maximum of 26 measurements were recorded (19 categorical and 7 continuous). From analysis of the minute-to-minute step rate and heart rate we derive several metrics associated with physical activity and cardiovascular function. These metrics are used to identify subgroups within the cohort and to compare to clinical parameters. Several Fitbit metrics are strongly correlated to continuous clinical parameters. Using a thresholding approach, we show that many Fitbit metrics result in statistically significant differences in clinical parameters between subgroups, including those associated with physical status, cardiovascular function, pulmonary function, as well as biomarkers from blood tests. These results highlight the fact that daily step count is only one of many metrics that can be derived from activity monitors.

Association of the Composite dietary antioxidant index with all-cause and cardiovascular mortality: A prospective cohort study

Background

According to epidemiological and experimental data, high individual dietary antioxidant intake is correlated with reduced cancer risk. The correlations between combined dietary antioxidants and the risk of all-cause and cardiovascular mortality remain unclear. Consequently, this study focused on evaluating the correlation between the food-derived Composite Dietary Antioxidant Index (CDAI) and all-cause and cardiovascular mortality.

Materials and methods

Two years of data collected from participants aged ≥20 years were included in this prospective cohort study, which was obtained from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The US NHANES adopted a complicated, multistage probability sampling method to collect health data representing the US population. Data collection was done through in-person interviews, virtual physical examinations, and laboratory tests. Mortality-related follow-up statistics from the start of the survey to 31 December 2019 were available. The shape of the correlation between CDAI and all-cause and cardiovascular mortality was inspected using a restricted cubic spline model. For CDAI and all-cause and cardiovascular mortality, the univariate- and multivariate-adjusted Cox proportional hazard models were estimated and presented as regression coefficients and 95% confidence intervals.

Results

In total, 44,031 NHANES participants represented 339.4 million non-institutionalized residents of the US (age, 47.2 ± 16.9 years; 52.5% women, 70.2% non-Hispanic whites, 10.8% non-Hispanic black people, and 7.5% Mexican Americans). In the 118-month follow-up, 9,249 deaths were reported, including 2,406 deaths resulting from heart disease and 519 deaths due to cerebrovascular disease. In the restricted cubic spline regression models, a linear relationship between CDAI and all-cause mortality was present. The weighted multivariate hazard ratios for all-cause mortality were computed to be 0.97 (0.87–1.07) for Q2, 0.88 (0.81–0.96) for Q3, and 0.90 (0.80–1.00) for Q4 (P for trend = 0.009) upon comparison with the lowest quartile of CDAI, and an identical trend was observed for cardiovascular mortality.

Conclusion

A high CDAI was linked to decreased all-cause and cardiovascular mortality risk. The intake of an antioxidant-rich diet significantly prevents cardiovascular mortality. To shed more light on these outcomes, more itemized investigations such as randomized control trials are required.

A longitudinal assessment of chronic care pathways in real-life: self-care and outcomes of chronic heart failure patients in Tuscany

Background

Worldwide healthcare systems face challenges in assessing and monitoring chronic care pathways and, even more, the value generated for patients. Patient-reported outcomes measures (PROMs) represent a valid Real-World Evidence (RWE) source to fully assess health systems’ performance in managing chronic care pathways.

Methods

The originality of the study consists in the chance of adopting PROMs, as a longitudinal assessment tool for continuous monitoring of patients’ adherence to therapies and self-care behavior recommendations in clinical practice and as a chance to provide policy makers insights to improve chronic pathways adopting a patient perspective. The focus was on PROMs of patients with chronic heart failure (CHF) collected in the Gabriele Monasterio Tuscan Foundation (FTGM), a tertiary referral CHF centre in Pisa, Italy. During the hospital stay, CHF patients were enrolled and received a link (via SMS or email) to access to the first questionnaire. Follow-up questionnaires were sent 1, 7 and 12 months after the index hospitalisation. Professionals invited 200 patients to participate to PROMs surveys. 174 answers were digitally collected at baseline from 2018 to 2020 and analysed. Quantitative and qualitative analyses were conducted, using Chi2, t-tests and regression models together with narrative evidence from free text responses.

Results

Both quantitative and qualitative results showed FTGM patients declared to strongly adhere to the pharmacological therapy across the entire pathway, while seemed less careful to adhere to self-care behavior recommendations (e.g., physical activity). CHF patients that performed adequate Self-Care Maintenance registered outcome improvements. Respondents declared to be supported by family members in managing their adherence.

Conclusions

The features of such PROMs collection model are relevant for researchers, policymakers and for managers to implement interventions aimed at improving pathway adherence dimensions. Among those, behavioral economics interventions could be implemented to increase physical activity among CHF patients since proven successful in Tuscany. Strategies to increase territorial care and support patients’ caregivers in their daily support to patients’ adherence should be further explored. Systematic PROMs collection would allow to monitor changes in the whole pathway organization. This study brings opportunities for extending such monitoring systems to other organizations to allow for reliable benchmarking opportunities.

Adherence to Secondary Prevention Measures after Acute Coronary Syndrome in Patients Associated Exclusively with the Public and Private Healthcare Systems in Brazil

Adherence to secondary prevention measures after acute coronary syndrome (ACS) is essential to prevent disease recurrence. In Brazil, the Brazilian Unified Health System (SUS, in Portuguese), and the private healthcare system (PHCS) coexist. We aimed to evaluate the adherence to secondary prevention in patients with ACS who were assisted by either SUS or PHCS. In this longitudinal prospective study, patients with ACS were admitted to the four cardiological reference hospitals of Sergipe, three of which assisted PHCS users, and one, SUS users. We analyzed the two patient care models with multiple logistic regression models for adherence to physical activity, pharmacotherapy, and smoking cessation. We enrolled 581 volunteers in this study: 44.1 % from SUS and 55.9 % from PHCS. PHCS users showed greater adherence to pharmacotherapy at both 30 and 180 (p = 0.001) days after ACS with better results in all classes of medications (p < 0.05) than SUS users did. They also showed better adherence to physical activity (p = 0.047). There was no distinction between the groups regarding smoking cessation. The secondary prevention measures after ACS were more effective in PHCS users than in SUS users due to better adherence, especially to pharmacotherapy and regular physical activity.

Guidelines for dyslipidemia management in India: A review of the current scenario and gaps in research

Cardiovascular Diseases (CVD) have a high disease burden in India. Dyslipidemia, a major CVD risk factor, requires effective management.

Our review describes the appropriateness of the international dyslipidemia guidelines in the Indian context. A systematic search was performed in PubMed, Google Scholar, Cochrane Library and Science Direct to obtain relevant articles.

Dyslipidemia management guidelines by western medical associations are based on their studies, with ethnic minorities underrepresented and biological features of other racial groups inadequately incorporated. The Lipid Association of India (LAI) came up with a consensus statement guided by an expert panel to adapt the western guidelines to Indians. However, absence of Indian guidelines has led to physicians basing treatment on individual preference, contributing to heterogeneity. Our review underscores the need for formulating Indian dyslipidemia management guidelines and CV risk estimation algorithms, highlighting the scope for further research. This could supplement the clinical expertise of LAI and enhance patient experience.

Optical electrocardiogram monitor with a real-time analysis of an abnormal heart rhythm for home-based medical alerts

Sudden cardiac death (SCD) caused by cardiovascular disease is the greatest hidden danger to human life, accounting for about 25% of the total deaths in the world. Due to the early concealment of SCD and the heavy medical burden of long-term examination, telemedicine combined with home monitoring has become a potential medical alert method. Among all the existing human cardiac and electrophysiology monitoring methods, optics-based sensors attract the widest attention due to the advantages of low delay, real-time monitoring, and high signal-to-noise ratio. In this paper, we propose an optical sensor with the capabilities of long-term monitoring and real-time analysis. Combining an R-peak recognition algorithm, Lorenz plots (LP), and statistical analysis, we carried out the consistency analysis and result visualization of ECG sequences over 1 h. The results of 10 subjects show that the R-peak recognition accuracy of the optical ECG monitor is higher than 97.99%. The optical system can display abnormal heart rhythm in real-time through LP, and the readability is good, which makes the system suitable for self-monitoring at home. In addition, this paper provides a detailed long-term monitoring assessment method to effectively guide the practical clinical transformation of other optical wearable devices.

Impacts on Context Aware Systems in Evidence-Based Health Informatics: A Review

Background: The application of Context Aware Computing (CAC) can be an effective, useful, feasible, and acceptable way to advance medical research and provide health services. Methods: This review was conducted in accordance with the principles of the development of a mixed methods review and existing knowledge in the field via the Synthesis Framework for the Assessment of Health Information Technology to evaluate CAC implemented by Evidence-Based Health Informatics (EBHI). A systematic search of the literature was performed during 18 November 2021–22 January 2022 in Cochrane Library, IEEE Xplore, PUBMED, Scopus and in the clinical registry platform Clinicaltrials.gov. The author included the articles in the review if they were implemented by EBHI and concerned with CAC technologies. Results: 29 articles met the inclusion criteria and refer to 26 trials published between 2011 and 2022. The author noticed improvements in healthcare provision using EBHI in the findings of CAC application. She also confirmed that CAC systems are a valuable and reliable method in health care provision. Conclusions: The use of CAC systems in healthcare is a promising new area of research and development. The author presented that the evaluation of CAC systems in EBHI presents positive effects on the state of health and the management of long-term diseases. These implications are presented in this article in a detailed, clear, and reliable manner.

Feasibility of a Wearable-Based Physical Activity Goal-Setting Intervention Among Individuals With Anterior Cruciate Ligament Reconstruction

CONTEXT

Individuals with a history of anterior cruciate ligament reconstruction (ACLR) demonstrate persistent reductions in physical activity (PA) volume that are not being addressed during rehabilitation. Currently, it is challenging for clinicians to prescribe exercise interventions that extend beyond in-person rehabilitative care in a manner that is responsive and acceptable to patients.

OBJECTIVE

To investigate the feasibility of using a novel, technology-driven, personalized goal-setting intervention over a 2-month period among young individuals with a history of primary unilateral ACLR.

DESIGN

Single-blinded feasibility study.

SETTING

University community.

PATIENTS OR OTHER PARTICIPANTS

Ten women and 2 men (age = 22.0 ± 3.0 years, time since surgery = 56.0 ± 36.3 months) with a history of primary unilateral ACLR.

INTERVENTION(S)

All participants completed a 28-day PA observation period immediately followed by a 28-day individualized PA goal-setting intervention period delivered via a commercially available PA monitor.

MAIN OUTCOME MEASURE(S)

Primary feasibility outcomes were days of PA monitor wear compliance and days of goal achievement during the intervention period. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) at study enrollment and after the intervention period, and the individual change in the KOOS Quality of Life subscale was compared with the minimal detectable change (7.2 points).

RESULTS

Average PA monitor wear compliance was 95.5% ± 7.3% during the observation period and 97.7% ± 2.9% during the intervention period. Median goal achievement was 31.5% ± 6.8% during the intervention period. Five participants demonstrated meaningful improvements in the KOOS Quality of Life subscale during the study period.

CONCLUSIONS

Individualized goal setting via mobile technology appears to be a feasible approach to PA promotion. However, based on the low rate of daily goal attainment during the intervention period, continued refinement of this intervention aproach would be beneficial before broad clinical implementation.

The Benefits of Telemedicine in Personalized Prevention of Cardiovascular Diseases (CVD): A Systematic Review

INTRODUCTION

Adverse effects on personalized care and outcomes of cardiovascular diseases (CVD) could occur if health systems do not work in an efficient manner. The pandemic caused by COVID-19 has opened new perspectives for the execution and advancement of cardiovascular tests through telemedicine platforms.

OBJECTIVE

This study aimed to analyze the usefulness of telemedical systems for providing personal care in the prevention of CVD.

METHODS

A systematic review analysis was conducted on the literature available from libraries such as PubMed (Medline), Scopus (Embase), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Data available in the last 10 years (2011-2020) were also examined by PRISMA guidelines. The selected studies were divided into two categories: (1) benefits of telemedicine in CVD prevention, and (2) recent progress in telemedical services for personalized care of CVD.

RESULTS

The literature search produced 587 documents, and 19 articles were considered in this review. Results highlighted that the timely delivery of preventive care for CVD which can be implemented virtually can benefit and modify morbidity and mortality. This could also reduce the pressure on hospitals by decreasing acute CVD occurrence among the general population. The use of these technologies can also help to reduce access to hospitals and other medical devices when not necessary.

CONCLUSIONS

Telemedicine platforms can be used for regular checkups for CVD and contribute to preventing the occurrence of acute events and more in general the progression of CVD.

Molecular genetic study on GATA5 gene promoter in acute myocardial infarction

Background

Acute myocardial infarction (AMI) is a severe type of coronary artery disease, caused by coronary occlusion and followed by cardiac ischaemia. GATA binding protein 5 (GATA5) is an important member of GATA family and plays an important role in vascular inflammation, endothelial function, oxidative stress and cell metabolism. Previous studies have shown that the DNA sequence variants (DSVs) in GATA4 and GATA6 promoter can increase susceptibility to AMI. In this study, we explored the relationship between GATA5 promoter and AMI for the first time, hoping to provide a new genetic basis for understanding the pathogenesis of AMI.

Methods

GATA5 promoter was sequenced in 683 individuals (332 AMI patients and 351 controls). The transcriptional activity of the GATA5 promoter with or without DSVs in HEK-293 cells, H9c2 cells and primary neonatal rat cardiomyocytes were examined by Promega Dual-Luciferase® Reporter Assay system. Electrophoretic mobility shift assay (EMSA) was performed to explore whether the DSVs interfered with the binding of transcription factors (TFs).

Results

Nine mutations have been found in GATA5 promoter, eight of them evidently altered the transcriptional activity of the GATA5 promoter, five of them disrupted the binding of TFs (such as farnesoid X receptor). Furthermore, haplotype AT (across rs80197101 and rs77067995) is a dangerous haplotype of AMI. Genotype GA and allele A of rs80197101 and genotype CT and allele T of rs77067995 are the risk factors of AMI.

Conclusions

DSVs in GATA5 promoter can increase susceptibility to AMI. But the mechanism remains to be verified in vivo.

Changing the Health Behavior of Patients With Cardiovascular Disease Through an Electronic Health Intervention in Three Different Countries: Cost-Effectiveness Study in the Do Cardiac Health: Advanced New Generation Ecosystem (Do CHANGE) 2 Randomized Controlled Trial

BACKGROUND

During the last few decades, preventing the development of cardiovascular disease has become a mainstay for reducing cardiovascular morbidity and mortality. It has been suggested that interventions should focus more on committed approaches of self-care, such as electronic health techniques.

OBJECTIVE

This study aimed to provide evidence to understand the financial consequences of implementing the "Do Cardiac Health: Advanced New Generation Ecosystem" (Do CHANGE 2) intervention, which was evaluated in a multisite randomized controlled trial to change the health behavior of patients with cardiovascular disease.

METHODS

The cost-effectiveness analysis of the Do CHANGE 2 intervention was performed with the Monitoring and Assessment Framework for the European Innovation Partnership on Active and Healthy Ageing tool, based on a Markov model of five health states. The following two types of costs were considered for both study groups: (1) health care costs (ie, costs associated with the time spent by health care professionals on service provision, including consultations, and associated unplanned hospitalizations, etc) and (2) societal costs (ie, costs attributed to the time spent by patients and informal caregivers on care activities).

RESULTS

The Do CHANGE 2 intervention was less costly in Spain (incremental cost was -€2514.90) and more costly in the Netherlands and Taiwan (incremental costs were €1373.59 and €1062.54, respectively). Compared with treatment as usual, the effectiveness of the Do CHANGE 2 program in terms of an increase in quality-adjusted life-year gains was slightly higher in the Netherlands and lower in Spain and Taiwan.

CONCLUSIONS

In general, we found that the incremental cost-effectiveness ratio strongly varied depending on the country where the intervention was applied. The Do CHANGE 2 intervention showed a positive cost-effectiveness ratio only when implemented in Spain, indicating that it saved financial costs in relation to the effect of the intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03178305; https://clinicaltrials.gov/ct2/show/NCT03178305.