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Arrow C, Ward M, Eshraghian J, Dwivedi G. Capturing the pulse: a state-of-the-art review on camera-based jugular vein assessment. BIOMEDICAL OPTICS EXPRESS 2023; 14:6470-6492. [PMID: 38420308 PMCID: PMC10898581 DOI: 10.1364/boe.507418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 03/02/2024]
Abstract
Heart failure is associated with a rehospitalisation rate of up to 50% within six months. Elevated central venous pressure may serve as an early warning sign. While invasive procedures are used to measure central venous pressure for guiding treatment in hospital, this becomes impractical upon discharge. A non-invasive estimation technique exists, where the clinician visually inspects the pulsation of the jugular veins in the neck, but it is less reliable due to human limitations. Video and signal processing technologies may offer a high-fidelity alternative. This state-of-the-art review analyses existing literature on camera-based methods for jugular vein assessment. We summarize key design considerations and suggest avenues for future research. Our review highlights the neck as a rich imaging target beyond the jugular veins, capturing comprehensive cardiac signals, and outlines factors affecting signal quality and measurement accuracy. Addressing an often quoted limitation in the field, we also propose minimum reporting standards for future studies.
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Affiliation(s)
- Coen Arrow
- School of Medicine, University of Western Australia, Perth, Australia
- Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia
| | - Max Ward
- Department of Computer Science and Software Engineering, University of Western Australia, Perth, Australia
| | - Jason Eshraghian
- Department of Electrical and Computer Engineering, University of California (Santa Cruz), California, USA
| | - Girish Dwivedi
- School of Medicine, University of Western Australia, Perth, Australia
- Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
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2
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He Q, Geng W, Li W, Wang RK. Non-contact measurement of neck pulses achieved by imaging micro-motions in the neck skin. BIOMEDICAL OPTICS EXPRESS 2023; 14:4507-4519. [PMID: 37791270 PMCID: PMC10545184 DOI: 10.1364/boe.501749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 10/05/2023]
Abstract
We report a method and system of micro-motion imaging (µMI) to realize non-contact measurement of neck pulses. The system employs a 16-bit camera to acquire videos of the neck skin, containing reflectance variation caused by the neck pulses. Regional amplitudes and phases of pulse-induced reflection variation are then obtained by applying a lock-in amplification algorithm to the acquired videos. Composite masks are then generated using the raw frame, amplitude and phase maps, which are then used to guide the extraction of carotid pulse (CP) and jugular vein pulse (JVP) waveforms. Experimental results sufficiently demonstrate the feasibility of our method to extract CP and JVP waves. Compared with conventional methods, the proposed strategy works in a non-contact, non-invasive and self-guidance manner without a need for manual identification to operate, which is important for patient compliance and measurement objectivity. Considering the close relationship between neck pulses and cardiovascular diseases, for example, CA stenosis, the proposed µMI system and method may be useful in the development of early screening tools for potential cardiovascular diseases.
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Affiliation(s)
- Qinghua He
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- Department of Ophthalmology, University of Washington, Seattle, WA 98105, USA
| | - Wenqian Geng
- Department of Ophthalmology, University of Washington, Seattle, WA 98105, USA
- Department of Hepatobiliary and Pancreatic Medicine, The first Hospital of Jilin University NO.71 Xinmin Street, Changchun, Jilin 130021, China
| | - Wanyu Li
- Department of Ophthalmology, University of Washington, Seattle, WA 98105, USA
- Department of Hepatobiliary and Pancreatic Medicine, The first Hospital of Jilin University NO.71 Xinmin Street, Changchun, Jilin 130021, China
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- Department of Ophthalmology, University of Washington, Seattle, WA 98105, USA
- Department of Hepatobiliary and Pancreatic Medicine, The first Hospital of Jilin University NO.71 Xinmin Street, Changchun, Jilin 130021, China
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3
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Liu W, Lin X, Chen X, Wang Q, Wang X, Yang B, Cai N, Chen R, Chen G, Lin Y. Vision-based estimation of MDS-UPDRS scores for quantifying Parkinson's disease tremor severity. Med Image Anal 2023; 85:102754. [PMID: 36702036 DOI: 10.1016/j.media.2023.102754] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 01/07/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative movement disorder among older individuals. As one of the typical symptoms of PD, tremor is a critical reference in the PD assessment. A widely accepted clinical approach to assessing tremors in PD is based on part III of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). However, expert assessment of tremor is a time-consuming and laborious process that poses considerable challenges to the medical evaluation of PD. In this paper, we proposed a novel model, Global Temporal-difference Shift Network (GTSN), to estimate the MDS-UPDRS score of PD tremors based on video. The PD tremor videos were scored according to the majority vote of multiple raters. We used Eulerian Video Magnification (EVM) pre-processing to enhance the representations of subtle PD tremors in the videos. To make the model better focus on the tremors in the video, we proposed a special temporal difference module, which stacks the current optical flow to the result of inter-frame difference. The prediction scores were obtained from the Residual Networks (ResNet) embedded with a novel module, the Global Shift Module (GSM), which allowed the features of the current segment to include the global segment features. We carried out independent experiments using PD tremor videos of different body parts based on the scoring content of the MDS-UPDRS. On a fairly large dataset, our method achieved an accuracy of 90.6% for hands with rest tremors, 85.9% for tremors in the leg, and 89.0% for the jaw. An accuracy of 84.9% was obtained for postural tremors. Our study demonstrated the effectiveness of computer-assisted assessment for PD tremors based on video analysis. The latest version of the code is available at https://github.com/199507284711/PD-GTSN.
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Affiliation(s)
- Weiping Liu
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China; Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou 350007, China
| | - Xiaozhen Lin
- Department of Geriatrics, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Xinghong Chen
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China; Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou 350007, China
| | - Qing Wang
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China; Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou 350007, China
| | - Xiumei Wang
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China; Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou 350007, China
| | - Bin Yang
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China; Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou 350007, China
| | - Naiqing Cai
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Rong Chen
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China; Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou 350007, China
| | - Guannan Chen
- Key Laboratory of OptoElectronic Science and Technology for Medicine of Ministry of Education, Fujian Normal University, Fuzhou 350007, China; Fujian Provincial Key Laboratory of Photonics Technology, Fujian Normal University, Fuzhou 350007, China.
| | - Yu Lin
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China.
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4
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Tisdale RL, Ferguson J, Van Campen J, Greene L, Sandhu AT, Heidenreich PA, Zulman DM. Disparities in virtual cardiology visits among Veterans Health Administration patients during the COVID-19 pandemic. JAMIA Open 2022; 5:ooac103. [PMID: 36531138 PMCID: PMC9754629 DOI: 10.1093/jamiaopen/ooac103] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 10/06/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Objective In response to the coronavirus disease 2019 (COVID-19) pandemic, the Veterans Health Administration (VA) rapidly expanded virtual care (defined as care delivered by video and phone), raising concerns about technology access disparities (ie, the digital divide). Virtual care was somewhat established in primary care and mental health care prepandemic, but video telehealth implementation was new for most subspecialties, including cardiology. We sought to identify patient characteristics of virtual and video-based care users in VA cardiology clinics nationally during the first year of the COVID-19 pandemic. Materials and Methods Cohort study of Veteran patients across all VA facilities with a cardiology visit January 1, 2019-March 10, 2020, with follow-up January 1, 2019-March 10, 2021. Main measures included cardiology visits by visit type and likelihood of receiving cardiology-related virtual care, calculated with a repeated event survival model. Results 416 587 Veterans with 1 689 595 total cardiology visits were analyzed; average patient age was 69.6 years and 4.3% were female. Virtual cardiology care expanded dramatically early in the COVID-19 pandemic from 5% to 70% of encounters. Older, lower-income, and rural-dwelling Veterans and those experiencing homelessness were less likely to use video care (adjusted hazard ratio for ages 75 and older 0.80, 95% confidence interval (CI) 0.75-0.86; for highly rural residents 0.77, 95% CI 0.68-0.87; for low-income status 0.94, 95% CI 0.89-0.98; for homeless Veterans 0.85, 95% CI 0.80-0.92). Conclusion The pandemic worsened the digital divide for cardiology care for many vulnerable patients to the extent that video visits represent added value over phone visits. Targeted interventions may be necessary for equity in COVID-19-era access to virtual cardiology care.
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Affiliation(s)
- Rebecca L Tisdale
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Department of Health Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - Jacqueline Ferguson
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA
| | - James Van Campen
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Liberty Greene
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Medicine, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Donna M Zulman
- Health Services Research and Development, Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA, USA.,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Tsai CH, Huang CC, Hsiao HM, Hung MY, Su GJ, Lin LH, Chen YH, Lin MS, Yeh CF, Hung CS, Kao HL. Detection of Carotid Artery Stenosis Based on Video Motion Analysis for Fast Screening. J Am Heart Assoc 2022; 11:e025702. [PMID: 35975739 PMCID: PMC9496434 DOI: 10.1161/jaha.122.025702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Carotid artery stenosis (CAS) is a common cause of ischemic stroke, and the early detection of CAS may improve patient outcomes. Carotid Doppler ultrasound is commonly used to diagnose CAS. However, it is costly and may not be practical for regular screening practice. This article presents a novel noninvasive and noncontact detection technique using video‐based motion analysis (VMA) to extract useful information from subtle pulses on the skin surface to screen for CAS. Methods and Results We prospectively enrolled 202 patients with prior carotid Doppler ultrasound data. A short 30‐second video clip of the neck was taken using a commercial mobile device and analyzed by VMA with mathematical quantification of the amplitude of skin motion changes in a blinded manner. The first 40 subjects were used to set up the VMA protocol and define cutoff values, and the following 162 subjects were used for validation. Overall, 54% of the 202 subjects had ultrasound‐confirmed CAS. Using receiver operating characteristic curve analysis, the area under the curve of VMA‐derived discrepancy values to differentiate patients with and without CAS was excellent (area under the curve, 0.914 [95% CI, 0.874–0.954]; P<0.01). The best cutoff value of VMA‐derived discrepancy values to screen for CAS was 5.1, with a sensitivity of 87% and a specificity of 87%. The diagnostic accuracy was consistently high in different subject subgroups. Conclusions A simple and accurate screening technique to quickly screen for CAS using a VMA system is feasible, with acceptable sensitivity and specificity.
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Affiliation(s)
- Cheng-Hsuan Tsai
- Graduate Institute of Clinical Medicine National Taiwan University College of Medicine Taipei Taiwan.,Division of Cardiology, Department of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei Taiwan
| | - Ching-Chang Huang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei Taiwan
| | - Hao-Ming Hsiao
- Department of Mechanical Engineering National Taiwan University Taipei Taiwan
| | - Ming-Ya Hung
- Department of Mechanical Engineering National Taiwan University Taipei Taiwan
| | - Guan-Jie Su
- Department of Mechanical Engineering National Taiwan University Taipei Taiwan
| | - Li-Han Lin
- Department of Mechanical Engineering National Taiwan University Taipei Taiwan
| | - Ying-Hsien Chen
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei Taiwan
| | - Mao-Shin Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei Taiwan
| | - Chih-Fan Yeh
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei Taiwan
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei Taiwan
| | - Hsien-Li Kao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular Center National Taiwan University Hospital Taipei Taiwan
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6
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Almarshad MA, Islam MS, Al-Ahmadi S, BaHammam AS. Diagnostic Features and Potential Applications of PPG Signal in Healthcare: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10030547. [PMID: 35327025 PMCID: PMC8950880 DOI: 10.3390/healthcare10030547] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
Recent research indicates that Photoplethysmography (PPG) signals carry more information than oxygen saturation level (SpO2) and can be utilized for affordable, fast, and noninvasive healthcare applications. All these encourage the researchers to estimate its feasibility as an alternative to many expansive, time-wasting, and invasive methods. This systematic review discusses the current literature on diagnostic features of PPG signal and their applications that might present a potential venue to be adapted into many health and fitness aspects of human life. The research methodology is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020. To this aim, papers from 1981 to date are reviewed and categorized in terms of the healthcare application domain. Along with consolidated research areas, recent topics that are growing in popularity are also discovered. We also highlight the potential impact of using PPG signals on an individual’s quality of life and public health. The state-of-the-art studies suggest that in the years to come PPG wearables will become pervasive in many fields of medical practices, and the main domains include cardiology, respiratory, neurology, and fitness. Main operation challenges, including performance and robustness obstacles, are identified.
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Affiliation(s)
- Malak Abdullah Almarshad
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
- Computer Science Department, College of Computer and Information Sciences, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh 11432, Saudi Arabia
- Correspondence:
| | - Md Saiful Islam
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
| | - Saad Al-Ahmadi
- Computer Science Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia; (M.S.I.); (S.A.-A.)
| | - Ahmed S. BaHammam
- The University Sleep Disorders Center, Department of Medicine, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia;
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7
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Amelard R, Robertson AD, Patterson CA, Heigold H, Saarikoski E, Hughson RL. Optical Hemodynamic Imaging of Jugular Venous Dynamics During Altered Central Venous Pressure. IEEE Trans Biomed Eng 2021; 68:2582-2591. [PMID: 33769929 DOI: 10.1109/tbme.2021.3069133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE An optical imaging system is proposed for quantitatively assessing jugular venous response to altered central venous pressure. METHODS The proposed system assesses sub-surface optical absorption changes from jugular venous waveforms with a spatial calibration procedure to normalize incident tissue illumination. Widefield frames of the right lateral neck were captured and calibrated using a novel flexible surface calibration method. A hemodynamic optical model was derived to quantify jugular venous optical attenuation (JVA) signals, and generate a spatial jugular venous pulsatility map. JVA was assessed in three cardiovascular protocols that altered central venous pressure: acute central hypovolemia (lower body negative pressure), venous congestion (head-down tilt), and impaired cardiac filling (Valsalva maneuver). RESULTS JVA waveforms exhibited biphasic wave properties consistent with jugular venous pulse dynamics when time-aligned with an electrocardiogram. JVA correlated strongly (median, interquartile range) with invasive central venous pressure during graded central hypovolemia (r = 0.85, [0.72, 0.95]), graded venous congestion (r = 0.94, [0.84, 0.99]), and impaired cardiac filling (r = 0.94, [0.85, 0.99]). Reduced JVA during graded acute hypovolemia was strongly correlated with reductions in stroke volume (SV) (r = 0.85, [0.76, 0.92]) from baseline (SV: 79 ± 15 mL, JVA: 0.56 ± 0.10 a.u.) to -40 mmHg suction (SV: 59 ± 18 mL, JVA: 0.47 ± 0.05 a.u.; p 0.01). CONCLUSION The proposed non-contact optical imaging system demonstrated jugular venous dynamics consistent with invasive central venous monitoring during three protocols that altered central venous pressure. SIGNIFICANCE This system provides non-invasive monitoring of pressure-induced jugular venous dynamics in clinically relevant conditions where catheterization is traditionally required, enabling monitoring in non-surgical environments.
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Abstract
Heart failure is a common disease state that can be encountered at different stages in the course of a COVID-19 patient presentation. New or existing heart failure in the setting of COVID-19 can present a set of unique challenges that can complicate presentation, management, and prognosis. A careful understanding of the hemodynamic and diagnostic implications is essential for appropriate triage and management of these patients. Abnormal cardiac biomarkers are common in COVID-19 and can stem from a variety of mechanisms that involve the viral entry itself through the ACE2 receptors, direct cardiac injury, increased thrombotic activity, stress cardiomyopathy, and among others. The cytokine storm observed in this pandemic can be a culprit in many of the observed mechanisms and presentations. A correct understanding of the two-way interaction between heart failure medications and the infection as well as the proposed COVID-19 medications and heart failure can result in optimal management. Guideline-directed medical therapy for heart failure should not be interrupted for theoretical concerns but rather based on tolerance and clinical presentation. Initiating specific cardiac or heart failure medications to prevent the infection or mitigate the disease is also not an evidence-based practice at this time. Heart failure patients on advanced therapies including those with heart transplantation will particularly benefit from involving the advanced heart failure team members in the overall management if they contract the virus.
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Affiliation(s)
- Feras Bader
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates.
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Yosef Manla
- Department of Research and Education, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates
| | - Bassam Atallah
- Department of Pharmacy Services, Cleveland Clinic Abu Dhabi, Al Maryah Island, PO Box 112412, Abu Dhabi, United Arab Emirates
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, OH, USA
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9
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Kerr B, Pharithi RB, Barrett M, Halley C, Gallagher J, Ledwidge M, McDonald K. Changing to remote management of a community heart failure population during COVID-19 - Clinician and patient perspectives'. IJC HEART & VASCULATURE 2020; 31:100665. [PMID: 33106775 PMCID: PMC7577653 DOI: 10.1016/j.ijcha.2020.100665] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/29/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The COVID pandemic has challenged the traditional methods used in care of patients with heart failure (HF). Remote management of HF patients has been recommended in order to maintain routine standards of care, but satisfaction with this platform of care is unknown. We set out to address the physician and patient opinion of remote management of HF during COVID-19. METHODS AND RESULTS An observational report of the use of a Structured Telephonic assessment (STA) in stable outpatient HF patients. Physician grading of the STA was complemented by 100 randomly chosen patients to ascertain patient satisfaction and comment. 278 patients underwent a STA. Patient preference for STA was noted in 66%. Convenience was the single most cited reason for this preference (83.3%). The STA was deemed satisfactory by clinicians in 67.6%. The two-leading reasons for clinician dissatisfaction were data gaps providing a barrier to titration (55.6%) and need for clinical exam (18.9%). The annual review appointment visit subtype possessed the highest levels of satisfaction congruence amongst both clinicians and patients. CONCLUSION In summary, this report demonstrates reasonable patient / physician satisfaction with STA, and provides some direction on how this care platform might be sustained beyond the COVID crisis.
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Key Words
- ARA, Annual review appointment
- BP, Blood pressure
- COVID-19
- DMP, Disease management programme
- F2F, Face to Face
- GP, General practitioner
- HF, Heart Failure
- HFrEF, Heart failure with reduced ejection fraction
- HR, Heart Rate
- HRPA, High risk patient appointment
- Heart failure
- Remote patient monitoring
- STA, Structured telephone assessment
- Telemedicine
- VC, Virtual consult
- YRS, Years
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Affiliation(s)
- Brian Kerr
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
- School of Medicine, University College Dublin, Dublin 4, Ireland1
| | - Rebabonye B. Pharithi
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
- School of Medicine, University College Dublin, Dublin 4, Ireland1
| | - Matthew Barrett
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
| | - Carmel Halley
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
| | - Joe Gallagher
- School of Medicine, University College Dublin, Dublin 4, Ireland1
| | - Mark Ledwidge
- School of Medicine, University College Dublin, Dublin 4, Ireland1
| | - Kenneth McDonald
- Heart Failure Unit, St Vincent University Hospital Healthcare Group, Elm Park, Dublin 4, Ireland1
- School of Medicine, University College Dublin, Dublin 4, Ireland1
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10
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Gorodeski EZ, Goyal P, Cox ZL, Thibodeau JT, Reay RE, Rasmusson K, Rogers JG, Starling RC. Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America. J Card Fail 2020; 26:448-456. [PMID: 32315732 PMCID: PMC7166039 DOI: 10.1016/j.cardfail.2020.04.008] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022]
Abstract
In response to the COVID-19 pandemic, US federal and state governments have implemented wide-ranging stay-at-home recommendations as a means to reduce spread of infection. As a consequence, many US healthcare systems and practices have curtailed ambulatory clinic visits—pillars of care for patients with heart failure (HF). In this context, synchronous audio/video interactions, also known as virtual visits (VVs), have emerged as an innovative and necessary alternative. This scientific statement outlines the benefits and challenges of VVs, enumerates changes in policy and reimbursement that have increased the feasibility of VVs during the COVID-19 era, describes platforms and models of care for VVs, and provides a vision for the future of VVs.
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Affiliation(s)
- Eiran Z Gorodeski
- Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH.
| | | | - Zachary L Cox
- Lipscomb University College of Pharmacy and Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Kismet Rasmusson
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
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