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Islam SMS, Daryabeygi-Khotbehsara R, Ghaffari MP, Uddin R, Gao L, Xu X, Siddiqui MU, Livingstone KM, Siopis G, Sarrafzadegan N, Schlaich M, Maddison R, Huxley R, Schutte AE. Burden of Hypertensive Heart Disease and High Systolic Blood Pressure in Australia from 1990 to 2019: Results From the Global Burden of Diseases Study. Heart Lung Circ 2023; 32:1178-1188. [PMID: 37743220 DOI: 10.1016/j.hlc.2023.06.853] [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: 01/30/2023] [Revised: 06/23/2023] [Accepted: 06/28/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND There is a dearth of comprehensive studies examining the burden and trends of hypertensive heart disease (HHD) and high systolic blood pressure (SBP) among the Australian population. We aimed to explore the burden of HHD and high SBP, and how they changed over time from 1990 to 2019 in Australia. METHODS We analysed data from the Global Burden of Disease study in Australia. We assessed the prevalence, mortality, disability-adjusted life-years (DALY), years lived with disability (YLD) and years of life lost (YLL) attributable to HHD and high SBP. Data were presented as point estimates with 95% uncertainty intervals (UI). We compared the burden of HHD and high SBP in Australia with World Bank defined high-income countries and six other comparator countries with similar sociodemographic characteristics and economies. RESULTS From 1990 to 2019, the burden of HHD and high SBP in Australia reduced. Age standardised prevalence rate of HHD was 119.3 cases per 100,000 people (95% UI 86.6-161.0) in 1990, compared to 80.1 cases (95% UI 57.4-108.1) in 2019. Deaths due to HDD were 3.4 cases per 100,000 population (95% UI 2.6-3.8) in 1990, compared to 2.5 (95% UI 1.9-3.0) in 2019. HHD contributed to 57.2 (95% UI 46.6-64.7) DALYs per 100,000 population in 1990 compared to 38.4 (95% UI 32.0-45.2) in 2019. Death rates per 100,000 population attributable to high SBP declined significantly over time for both sexes from 1990 (155.6 cases; 95% UI 131.2-177.0) to approximately one third in 2019 (53.8 cases; 95% UI 43.4-64.4). Compared to six other countries in 2019, the prevalence of HHD was highest in the USA (274.3%) and lowest in the UK (52.6%), with Australia displaying the third highest prevalence. Australia ranked second in term of lowest rates of deaths and third for lowest DALYs respectively due to high SBP. From 1990-2019, Australia ranked third best for reductions in deaths and DALYs due to HHD and first for reductions in deaths and DALYs due to high SBP. CONCLUSION Over the past three decades, the burden of HHD in Australia has reduced, but its prevalence remains relatively high. The contribution of high SBP to deaths, DALYs and YLLs also reduced over the three decades.
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Affiliation(s)
| | | | | | - Riaz Uddin
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Vic, Australia
| | - Lan Gao
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Vic, Australia
| | - Xiaoyue Xu
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Muhammad Umer Siddiqui
- Department of Internal Medicine, Thomas Jefferson University Hospital Philadelphia, PA, USA
| | | | - George Siopis
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Vic, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Markus Schlaich
- Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, The University of Western Australia, Perth, WA, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Vic, Australia
| | - Rachel Huxley
- Faculty of Health, Deakin University, Geelong, Vic, Australia
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
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2
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Willis M, Darwiche G, Carlsson M, Nilsson A, Wohlin J, Lindgren P. Real-world long-term effects on blood pressure and other cardiovascular risk factors for patients in digital therapeutics. Blood Press Monit 2023; 28:86-95. [PMID: 36729897 PMCID: PMC9981322 DOI: 10.1097/mbp.0000000000000633] [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] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/17/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Hypertension is a leading causeof premature death worldwide and a major public health problem. This study investigated the long-term effects (>1 year) of digital hypertension monitoring by home blood pressure (HBP) measurements in combination with individualized remote treatment via a Swedish Digital Therapeutics platform in a large patient population. METHODS The primary endpoint, HBP, and exploratory endpoints, BMI, alcohol consumption, stress level, physical activity, and smoking, were assessed every 3 months for 540 and 360 days, respectively, in 7752 Swedish primary hypertension patients. Patients received individualized medical treatments and lifestyle advice via asynchronous text-based communication in an app. Changes from baseline in endpoints were calculated for the whole population and for subgroups defined by baseline SBP ≥135 (high SBP), 125-135 (suboptimal SBP), 115-125 (optimal SBP), and <115 mmHg (low SBP). RESULTS After 360 days of treatment, the whole population showed a significant increase of 57% (from 37 to 58%) in the proportion of patients with controlled SBP (i.e. SBP of 115-135 mmHg). The largest reduction in SBP of 13.8 mmHg was observed for the high SBP subgroup, whereas for the low SBP subgroup, SBP increased by 13.4 mmHg. BP improved most in the first three months, and for both the high and low BP subgroups, the improvement continued during the 540-day study period. Significant beneficial changes were also observed for some exploratory endpoints including BMI and smoking. CONCLUSIONS In conclusion, the digital therapeutics platform was associated with significant improvement in BP control and associated risk factors, which were maintained over a longer period.
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Affiliation(s)
| | - Ghassan Darwiche
- Blodtrycksdoktorn AB, Stockholm
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö
| | - Martin Carlsson
- Blodtrycksdoktorn AB, Stockholm
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
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Culhane-Pera KA, Vang KB, Ortega LM, Xiong T, Northuis CA, de la Parra P, Lakshminarayan K. Mobile health technology for hypertension management with Hmong and Latino adults: mixed-methods community-based participatory research. ETHNICITY & HEALTH 2023; 28:413-430. [PMID: 35387531 PMCID: PMC9535036 DOI: 10.1080/13557858.2022.2059451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/23/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To identify Hmong and Latino adults' perspectives about a mHealth-based care model for hypertension (HTN) management involving blood pressure (BP) self-monitoring, electronic transmission of BP readings, and responsive HTN medication adjustment by a provider team. DESIGN We conducted a mixed-methods formative study with 25 Hmong and 25 Latino participants with HTN at an urban federally-qualified health center. We used a tool to assess HTN knowledge and conducted open-ended interviews to identify perspectives about mHealth-based care model. RESULTS While most participants agreed that lowering high blood pressure decreased the risk of strokes, heart attacks, and kidney failure, there were gaps in medical knowledge. Three major themes emerged about the mHealth-based care model: (1) Using mHealth technology could be useful, especially if assistance was available to patients with technological challenges; (2) Knowing blood pressures could be helpful, especially to patients who agreed with doctors' medical diagnosis and prescribed treatment; (3) Transmitting blood pressures to the clinic and their responsive actions could feel empowering, and the sense of increased surveillance could feel entrapping. Some people may feel empowered since it could increase patient-provider communication without burden of clinic visits and could increase involvement in BP control for those who agree with the medical model of HTN. However, some people may feel entrapped as it could breach patient privacy, interfere with patients' lifestyle choices, and curtail patient autonomy. CONCLUSIONS In general, Hmong and Latino adults responded positively to the empowering aspects of the mHealth-based care model, but expressed caution for those who had limited technological knowledge, who did not agree with the medical model and who may feel entrapped. In a shared decision-making approach with patients and possibly their family members, health care systems and clinicians should explore barriers and potential issues of empowerment and entrapment when offering a mHealth care model in practice.
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Affiliation(s)
| | | | | | - Txia Xiong
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, St Paul, MN, USA
| | - Carin A Northuis
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Pilar de la Parra
- SoLaHmo Partnership for Health and Wellness, Minnesota Community Care, St Paul, MN, USA
| | - Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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4
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Cao W, Milks MW, Liu X, Gregory ME, Addison D, Zhang P, Li L. mHealth Interventions for Self-management of Hypertension: Framework and Systematic Review on Engagement, Interactivity, and Tailoring. JMIR Mhealth Uhealth 2022; 10:e29415. [PMID: 35234655 PMCID: PMC8928043 DOI: 10.2196/29415] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/01/2021] [Accepted: 12/15/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Engagement is essential for the effectiveness of digital behavior change interventions. Existing systematic reviews examining hypertension self-management interventions via mobile apps have primarily focused on intervention efficacy and app usability. Engagement in the prevention or management of hypertension is largely unknown. OBJECTIVE This systematic review explores the definition and role of engagement in hypertension-focused mobile health (mHealth) interventions, as well as how determinants of engagement (ie, tailoring and interactivity) have been implemented. METHODS A systematic review of mobile app interventions for hypertension self-management targeting adults, published from 2013 to 2020, was conducted. A total of 21 studies were included in this systematic review. RESULTS The engagement was defined or operationalized as a microlevel concept, operationalized as interaction with the interventions (ie, frequency of engagement, time or duration of engagement with the program, and intensity of engagement). For all 3 studies that tested the relationship, increased engagement was associated with better biomedical outcomes (eg, blood pressure change). Interactivity was limited in digital behavior change interventions, as only 7 studies provided 2-way communication between users and a health care professional, and 9 studies provided 1-way communication in possible critical conditions; that is, when abnormal blood pressure values were recorded, users or health care professionals were notified. The tailoring of interventions varied at different aspects, from the tailoring of intervention content (including goals, patient education, advice and feedback from health professionals, reminders, and motivational messages) to the tailoring of intervention dose and communication mode. Tailoring was carried out in a number of ways, considering patient characteristics such as goals, preferences, disease characteristics (eg, hypertension stage and medication list), disease self-management experience levels, medication adherence rate, and values and beliefs. CONCLUSIONS Available studies support the importance of engagement in intervention effectiveness as well as the essential roles of patient factors in tailoring, interactivity, and engagement. A patient-centered engagement framework for hypertension self-management using mHealth technology is proposed here, with the intent of facilitating intervention design and disease self-management using mHealth technology.
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Affiliation(s)
- Weidan Cao
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - M Wesley Milks
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Xiaofu Liu
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Megan E Gregory
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), The Ohio State University College of Medicine, Columbus, OH, United States
| | - Daniel Addison
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ping Zhang
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
| | - Lang Li
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, United States
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Yue J, Yang X, Wang B, Hu H, Fu H, Gao Y, Sun G. Home blood pressure telemonitoring for improving blood pressure control in middle-aged and elderly patients with hypertension. J Clin Hypertens (Greenwich) 2021; 23:1744-1751. [PMID: 34350677 PMCID: PMC8678721 DOI: 10.1111/jch.14341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/10/2021] [Accepted: 07/19/2021] [Indexed: 01/16/2023]
Abstract
The blood pressure (BP) control rate among treated hypertensives in China remains low at 37.5%. The relationship between home blood pressure telemonitoring (HBPT) and BP control is controversial. The authors aimed to investigate the relationship between HBPT and BP control in middle‐aged and elderly hypertensives. In total, 252 hypertension patients aged between 60 and 79 years were enrolled. The patients were given either HBPT through interactive platforms between physicians and patients (telemonitoring group, n = 126) or conventional management (routine management group, n = 126). All patients were followed‐up for 15 months. BP control was defined as home systolic blood pressure < 135 mm Hg and home diastolic blood pressure < 85 mm Hg. At baseline, there were no significant differences in the baseline BP control rate (p = .083). However, after 15 months, the BP control rate improved in both groups, and the telemonitoring group (71.3%) had a significantly higher BP control than the routine management group (49.8%) (p < .001). The change of BP control rate from baseline in the routine management group increased by 26.1%, and that of the telemonitoring group increased by 35.4%. The results of the fully adjusted binary logistic regression showed that HBPT was positively associated with BP control after adjusting for confounders (OR = 4.15, 95% CI 2.05–8.39). Similar results were observed after 3, 9, and 12 months. The association of HBPT with BP control was similar in subgroups. In conclusions, HBPT is recommended for BP control in middle‐aged and elderly hypertensives in the community setting.
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Affiliation(s)
- Jianwei Yue
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China.,Research Institute of Hypertension, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, P.R. China
| | - Xiaomin Yang
- Research Institute of Hypertension, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, P.R. China
| | - Bin Wang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Han Hu
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Haiming Fu
- Department of Clinical Laboratory, Baotou Maternal and Child Health Center, Baotou, Inner Mongolia Autonomous Region, P.R. China
| | - Yuxia Gao
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, P.R. China
| | - Gang Sun
- Research Institute of Hypertension, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia, P.R. China
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6
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The impact of smart technology on adherence rates and fluid management in the prevention of kidney stones. Urolithiasis 2021; 50:29-36. [PMID: 34115205 DOI: 10.1007/s00240-021-01270-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
Smart technology (ST) can enhance chronic disease management, yet little is known about the benefits of ST on kidney stone prevention. Our aim was to prospectively evaluate the impact of ST on follow-up adherence rates and urine output (UOP) in patients with nephrolithiasis. Kidney stone patients with low UOP (< 2.5 L/24 h) were randomized into three intervention groups: (1) standard dietary/medical counseling alone (control), (2) control + smartphone fluid management application (app), and (3) control + smart water bottle (bottle). Demographics, adherence rates, kidney stone events, and 24 h urine data were collected and analyzed at baseline, 3-6, and 12 months. We randomized 111 patients (37 per group), of which 20 (55%), 8 (26%), and 10 (33%) patients completed the 12 month follow-up in the control, app, and bottle groups respectively. Control group patients were the most likely to adhere to follow-up (p = 0.004). Overall mean UOP increased by 0.4 L in each group (p < 0.05), with no difference in mean baseline 24 h UOP (1.6 L) and 12 month 24 h UOP (2.0 L) between groups (p > 0.05). Twenty-nine percent of patients achieved a daily UOP goal of > 2.5 L across the treatment groups (p < 0.001). In this prospective study, the 24 h UOP improved across all groups compared to baseline, although adherence to follow-up remained low. Furthermore, the use of ST did not further augment UOP, underscoring the importance of dietary/medical counseling for kidney stone prevention.
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7
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Lakshminarayan K, Murray TA, Westberg SM, Connett J, Overton V, Nyman JA, Culhane-Pera KA, Pergament SL, Drawz P, Vollbrecht E, Xiong T, Everson-Rose SA. Mobile Health Intervention to Close the Guidelines-To-Practice Gap in Hypertension Treatment: Protocol for the mGlide Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25424. [PMID: 33492231 PMCID: PMC7870345 DOI: 10.2196/25424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/29/2020] [Accepted: 12/18/2020] [Indexed: 12/29/2022] Open
Abstract
Background Suboptimal treatment of hypertension remains a widespread problem, particularly among minorities and socioeconomically disadvantaged groups. We present a health system–based intervention with diverse patient populations using readily available smartphone technology. This intervention is designed to empower patients and create partnerships between patients and their provider team to promote hypertension control. Objective The mGlide randomized controlled trial is a National Institutes of Health–funded study, evaluating whether a mobile health (mHealth)-based intervention that is an active partnership between interprofessional health care teams and patients results in better hypertension control rates than a state-of-clinical care comparison. Methods We are recruiting 450 participants including stroke survivors and primary care patients with elevated cardiovascular disease risk from diverse health systems. These systems include an acute stroke service (n=100), an academic medical center (n=150), and community medical centers including Federally Qualified Health Centers serving low-income and minority (Latino, Hmong, African American, Somali) patients (n=200). The primary aim tests the clinical effectiveness of the 6-month mHealth intervention versus standard of care. Secondary aims evaluate sustained hypertension control rates at 12 months; describe provider experiences of system usability and satisfaction; examine patient experiences, including medication adherence and medication use self-efficacy, self-rated health and quality of life, and adverse event rates; and complete a cost-effectiveness analysis. Results To date, we have randomized 107 participants (54 intervention, 53 control). Conclusions This study will provide evidence for whether a readily available mHealth care model is better than state-of-clinical care for bridging the guideline-to-practice gap in hypertension treatment in health systems serving diverse patient populations. Trial Registration Clinicaltrials.gov NCT03612271; https://clinicaltrials.gov/ct2/show/NCT03612271 International Registered Report Identifier (IRRID) DERR1-10.2196/25424
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Affiliation(s)
- Kamakshi Lakshminarayan
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Thomas A Murray
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Sarah M Westberg
- Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - John Connett
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Val Overton
- Fairview Health Services, Minneapolis, MN, United States
| | - John A Nyman
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Kathleen A Culhane-Pera
- SoLaHmo Partnership for Health and Wellness, Minneapolis, MN, United States.,Minnesota Community Care, Saint Paul, MN, United States
| | | | - Paul Drawz
- Division of Renal Disease and Hypertension, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Emily Vollbrecht
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Txia Xiong
- SoLaHmo Partnership for Health and Wellness, Minneapolis, MN, United States
| | - Susan A Everson-Rose
- Department of Medicine and Program in Health Disparities Research, Medical School, University of Minnesota, Minneapolis, MN, United States
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Kaushik A, Patel S, Dubey K. Digital cardiovascular care in COVID-19 pandemic: A potential alternative? J Card Surg 2020; 35:3545-3550. [PMID: 33040399 PMCID: PMC7675673 DOI: 10.1111/jocs.15094] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cardiovascular patients are at increased risk of acquiring coronavirus disease 2019 (COVID-19) infection while their visit to healthcare facilities. There is a need for alternative tools for optimal monitoring and management of cardiovascular patients in the present pandemic situation. Digital health care may prove to be a new revolutionary tool to protect cardiovascular patients from coronavirus disease by avoiding routine visits to health care facilities that are already overwhelmed with COVID-19 patients. METHODS To evaluate the role of digital health care in the present era of the COVID-19 pandemic, we have reviewed the published literature on digital health services providing cardiovascular care. RESULTS AND CONCLUSION Digital health including telemedicine services, robotic telemedicine carts, use of artificial intelligence and machine learning, use of digital gadgets like smartwatches and web-based applications may be a safe alternative for the management of cardiovascular patients in the present pandemic situation.
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Affiliation(s)
- Atul Kaushik
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Surendra Patel
- Department of Trauma and Emergency Cardiothoracic Surgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Kalika Dubey
- Department of Maternal and Reproductive Health, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India
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Buis LR, Roberson DN, Kadri R, Rockey NG, Plegue MA, Danak SU, Guetterman TC, Johnson MG, Choe HM, Richardson CR. Understanding the Feasibility, Acceptability, and Efficacy of a Clinical Pharmacist-led Mobile Approach (BPTrack) to Hypertension Management: Mixed Methods Pilot Study. J Med Internet Res 2020; 22:e19882. [PMID: 32780026 PMCID: PMC7448180 DOI: 10.2196/19882] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hypertension is a prevalent and costly burden in the United States. Clinical pharmacists within care teams provide effective management of hypertension, as does home blood pressure monitoring; however, concerns about data quality and latency are widespread. One approach to close the gap between clinical pharmacist intervention and home blood pressure monitoring is the use of mobile health (mHealth) technology. OBJECTIVE We sought to investigate the feasibility, acceptability, and preliminary effectiveness of BPTrack, a clinical pharmacist-led intervention that incorporates patient- and clinician-facing apps to make electronically collected, patient-generated data available to providers in real time for hypertension management. The patient app also included customizable daily medication reminders and educational messages. Additionally, this study sought to understand barriers to adoption and areas for improvement identified by key stakeholders, so more widespread use of such interventions may be achieved. METHODS We conducted a mixed methods pilot study of BPTrack, to improve blood pressure control in patients with uncontrolled hypertension through a 12-week pre-post intervention. All patients were recruited from a primary care setting where they worked with a clinical pharmacist for hypertension management. Participants completed a baseline visit, then spent 12 weeks utilizing BPTrack before returning to the clinic for follow-up. Collected data from patient participants included surveys pre- and postintervention, clinical measures (for establishing effectiveness, with the primary outcome being a change in blood pressure and the secondary outcome being a change in medication adherence), utilization of the BPTrack app, interviews at follow-up, and chart review. We also conducted interviews with key stakeholders. RESULTS A total of 15 patient participants were included (13 remained through follow-up for an 86.7% retention rate) in a single group, pre-post assessment pilot study. Data supported the hypothesis that BPTrack was feasible and acceptable for use by patient and provider participants and was effective at reducing patient blood pressure. At the 12-week follow-up, patients exhibited significant reductions in both systolic blood pressure (baseline mean 137.3 mm Hg, SD 11.1 mm Hg; follow-up mean 131.0 mm Hg, SD 9.9 mm Hg; P=.02) and diastolic blood pressure (baseline mean 89.4 mm Hg, SD 7.7 mm Hg; follow-up mean 82.5 mm Hg, SD 8.2 mm Hg; P<.001). On average, patients uploaded at least one blood pressure measurement on 75% (SD 25%) of study days. No improvements in medication adherence were noted. Interview data revealed areas of improvement and refinement for the patient experience. Furthermore, stakeholders require integration into the electronic health record and a modified clinical workflow for BPTrack to be truly useful; however, both patients and stakeholders perceived benefits of BPTrack when used within the context of a clinical relationship. CONCLUSIONS Results demonstrate that a pharmacist-led mHealth intervention promoting home blood pressure monitoring and clinical pharmacist management of hypertension can be effective at reducing blood pressure in primary care patients with uncontrolled hypertension. Our data also support the feasibility and acceptability of these types of interventions for patients and providers. TRIAL REGISTRATION ClinicalTrials.gov NCT02898584; https://clinicaltrials.gov/ct2/show/NCT02898584. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/resprot.8059.
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Affiliation(s)
- Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Dana N Roberson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Nicole G Rockey
- Pharmacy Innovations and Partnerships, University of Michigan Medical Group, Ann Arbor, MI, United States
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Melissa A Plegue
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Shivang U Danak
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Timothy C Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Melanie G Johnson
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
| | - Hae Mi Choe
- Pharmacy Innovations and Partnerships, University of Michigan Medical Group, Ann Arbor, MI, United States
- College of Pharmacy, University of Michigan, Ann Arbor, MI, United States
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10
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Mazoteras-Pardo V, Becerro-De-Bengoa-Vallejo R, Losa-Iglesias ME, Martínez-Jiménez EM, Calvo-Lobo C, Romero-Morales C, López-López D, Palomo-López P. QardioArm Blood Pressure Monitoring in a Population With Type 2 Diabetes: Validation Study. J Med Internet Res 2020; 22:e19781. [PMID: 32706672 PMCID: PMC7414407 DOI: 10.2196/19781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Home blood pressure monitoring has many benefits, even more so, in populations prone to high blood pressure, such as persons with diabetes. OBJECTIVE The purpose of this research was to validate the QardioArm mobile device in a sample of individuals with noninsulin-dependent type 2 diabetes in accordance with the guidelines of the second International Protocol of the European Society of Hypertension. METHODS The sample consisted of 33 patients with type 2 diabetes. To evaluate the validity of QardioArm by comparing its data with that obtained with a digital sphygmomanometer (Omron M3 Intellisense), two nurses collected diastolic blood pressure, systolic blood pressure, and heart rate with both devices. RESULTS The analysis indicated that the test device QardioArm met all the validation requirements using a sample population with type 2 diabetes. CONCLUSIONS This paper reports the first validation of QardioArm in a population of individuals with noninsulin-dependent type 2 diabetes. QardioArm for home monitoring of blood pressure and heart rate met the requirements of the second International Protocol of the European Society of Hypertension.
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Affiliation(s)
- Victoria Mazoteras-Pardo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Eva María Martínez-Jiménez
- Departamento de Enfermería, Facultad de Fisioterapia y Enfermería, Universidad de Castilla la Mancha, Toledo, Spain
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
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11
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Confronting the Post-ACA American Health Crisis: Designing Health Care for Value and Equity. J Ambul Care Manage 2020; 42:202-210. [PMID: 31136391 DOI: 10.1097/jac.0000000000000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The United States is in the midst of a health crisis marked by unprecedented 3-year declines in life expectancy. Addressing this national crisis requires alignment of public policies, public health policies, and health care policies, with the overarching aim of improving national health and health equity. Aligning national polices to support human needs provides a foundation for implementing post-Affordable Care Act national health care reform. Reform should start with the twin goals of improving health care value and equity. A focus on value, that is, outcomes and processes desired by patients, is critical to ensuring that resources are judiciously deployed to optimize individual and population health. A focus on health care equity ensures that the health care system is intentionally designed to minimize inequities in health care processes and outcomes, particularly for member of socially disadvantaged groups. All sectors related to the health care system-from policies and payment mechanisms to delivery design, measurement, patient engagement/democratization, training, and research-should be tightly aligned with improving health care value and equity during this next era of health care reform.
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12
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Mena LJ, Félix VG, Ostos R, González AJ, Martínez-Peláez R, Melgarejo JD, Maestre GE. Mobile Personal Health Care System for Noninvasive, Pervasive, and Continuous Blood Pressure Monitoring: Development and Usability Study. JMIR Mhealth Uhealth 2020; 8:e18012. [PMID: 32459642 PMCID: PMC7400045 DOI: 10.2196/18012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/11/2020] [Accepted: 04/26/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Smartphone-based blood pressure (BP) monitoring using photoplethysmography (PPG) technology has emerged as a promising approach to empower users with self-monitoring for effective diagnosis and control of hypertension. OBJECTIVE This study aimed to develop a mobile personal health care system for noninvasive, pervasive, and continuous estimation of BP level and variability, which is user friendly for elderly people. METHODS The proposed approach was integrated by a self-designed cuffless, calibration-free, wireless, and wearable PPG-only sensor and a native purposely designed smartphone app using multilayer perceptron machine learning techniques from raw signals. We performed a development and usability study with three older adults (mean age 61.3 years, SD 1.5 years; 66% women) to test the usability and accuracy of the smartphone-based BP monitor. RESULTS The employed artificial neural network model had good average accuracy (>90%) and very strong correlation (>0.90) (P<.001) for predicting the reference BP values of our validation sample (n=150). Bland-Altman plots showed that most of the errors for BP prediction were less than 10 mmHg. However, according to the Association for the Advancement of Medical Instrumentation and British Hypertension Society standards, only diastolic blood pressure prediction met the clinically accepted accuracy thresholds. CONCLUSIONS With further development and validation, the proposed system could provide a cost-effective strategy to improve the quality and coverage of health care, particularly in rural zones, areas lacking physicians, and areas with solitary elderly populations.
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Affiliation(s)
- Luis J Mena
- Academic Unit of Computing, Master Program in Applied Sciences, Universidad Politecnica de Sinaloa, Mazatlan, Mexico
| | - Vanessa G Félix
- Academic Unit of Computing, Master Program in Applied Sciences, Universidad Politecnica de Sinaloa, Mazatlan, Mexico
| | - Rodolfo Ostos
- Academic Unit of Computing, Master Program in Applied Sciences, Universidad Politecnica de Sinaloa, Mazatlan, Mexico
| | - Armando J González
- Academic Unit of Computing, Master Program in Applied Sciences, Universidad Politecnica de Sinaloa, Mazatlan, Mexico
| | | | - Jesus D Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Gladys E Maestre
- Departments of Neurosciences and Human Genetics, and Rio Grande Valley Alzheimer´s Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX, United States
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13
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Lopes MACQ, Oliveira GMMD, Ribeiro ALP, Pinto FJ, Rey HCV, Zimerman LI, Rochitte CE, Bacal F, Polanczyk CA, Halperin C, Araújo EC, Mesquita ET, Arruda JA, Rohde LEP, Grinberg M, Moretti M, Caramori PRA, Botelho RV, Brandão AA, Hajjar LA, Santos AF, Colafranceschi AS, Etges APBDS, Marino BCA, Zanotto BS, Nascimento BR, Medeiros CR, Santos DVDV, Cook DMA, Antoniolli E, Souza Filho EMD, Fernandes F, Gandour F, Fernandez F, Souza GEC, Weigert GDS, Castro I, Cade JR, Figueiredo Neto JAD, Fernandes JDL, Hadlich MS, Oliveira MAP, Alkmim MB, Paixão MCD, Prudente ML, Aguiar Netto MAS, Marcolino MS, Oliveira MAD, Simonelli O, Lemos Neto PA, Rosa PRD, Figueira RM, Cury RC, Almeida RC, Lima SRF, Barberato SH, Constancio TI, Rezende WFD. Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019. Arq Bras Cardiol 2020; 113:1006-1056. [PMID: 31800728 PMCID: PMC7020958 DOI: 10.5935/abc.20190205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Fernando Bacal
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Carisi Anne Polanczyk
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil.,Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | | | | | | | | | | | - Max Grinberg
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | - Miguel Moretti
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | - Roberto Vieira Botelho
- Instituto do Coração do Triângulo (ICT), Uberlândia, MG - Brazil.,International Telemedical Systems do Brasil (ITMS), Uberlândia, MG - Brazil
| | | | - Ludhmila Abrahão Hajjar
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP - Brazil
| | | | | | | | - Bárbara Campos Abreu Marino
- Hospital Madre Teresa, Belo Horizonte, MG - Brazil.,Pontifícia Universidade Católica de Minas Gerais (PUCMG), Belo Horizonte, MG - Brazil
| | - Bruna Stella Zanotto
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil.,Instituto de Avaliação de Tecnologias em Saúde (IATS), Porto Alegre, RS - Brazil
| | - Bruno Ramos Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | - Daniela Matos Arrowsmith Cook
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil.,Hospital Copa Star, Rio de Janeiro, RJ - Brazil.,Hospital dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ - Brazil
| | | | - Erito Marques de Souza Filho
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brazil.,Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ - Brazil
| | | | - Fabio Gandour
- Universidade de Brasília (UnB), Brasília, DF - Brazil
| | | | | | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brazil.,Fundação Universitária de Cardiologia, Porto Alegre, RS - Brazil
| | | | | | | | - Marcelo Souza Hadlich
- Fleury Medicina e Saúde, Rio de Janeiro, RJ - Brazil.,Rede D'Or, Rio de Janeiro, RJ - Brazil.,Unimed-Rio, Rio de Janeiro, RJ - Brazil
| | | | - Maria Beatriz Alkmim
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil.,Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil
| | | | | | | | | | | | - Osvaldo Simonelli
- Conselho Regional de Medicina do Estado de São Paulo, São Paulo, SP - Brazil.,Instituto Paulista de Direito Médico e da Saúde (IPDMS), Ribeirão Preto, SP - Brazil
| | | | - Priscila Raupp da Rosa
- Hospital Israelita Albert Einstein, São Paulo, SP - Brazil.,Hospital Sírio Libanês, São Paulo, SP - Brazil
| | | | | | | | | | - Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil.,Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
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14
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Kim DY, Kwon H, Nam KW, Lee Y, Kwon HM, Chung YS. Remote Management of Poststroke Patients With a Smartphone-Based Management System Integrated in Clinical Care: Prospective, Nonrandomized, Interventional Study. J Med Internet Res 2020; 22:e15377. [PMID: 32130140 PMCID: PMC7068458 DOI: 10.2196/15377] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/24/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022] Open
Abstract
Background Advances in mobile health (mHealth) have enabled systematic and continuous management of patients with chronic diseases. Objective We developed a smartphone-based mHealth system and aimed to evaluate its effects on health behavior management and risk factor control in stroke patients. Methods With a multifaceted stroke aftercare management system that included exercise, medication, and educational materials, we performed a 12-week single-arm intervention among eligible poststroke patients in the stroke clinic from September to December 2016. The intervention consisted of (1) regular blood pressure (BP), blood glucose, and physical activity measurements; (2) stroke education; (3) an exercise program; (4) a medication program; and (5) feedback on reviewing of records by clinicians. Clinical assessments consisted of the stroke awareness score, Beck Depression Inventory-II (BDI), EuroQol-5 Dimensions (EQ-5D), and BP at visit 1 (baseline), visit 2 (4 weeks), and visit 3 (12 weeks). Temporal differences in the parameters over 12 weeks were investigated with repeated-measures analysis of variance. Changes in medication adherence at visit 1-2 (from visit 1 to visit 2) and visit 2-3 (from visit 2 to visit 3) were compared. System satisfaction was evaluated with a self-questionnaire using a 5-point Likert scale at visit 3. Results The study was approved by the Institutional Review Board in September 2016, and participants were enrolled from September to December 2016. Among the 110 patients enrolled for the study, 99 were included in our analyses. The mean stroke awareness score (baseline: 59.6 [SD 18.1]; 4 weeks: 67.6 [SD 16.0], P<.001; 12 weeks: 74.7 [SD 14.0], P<.001) and BDI score (baseline: 12.7 [SD 10.1]; 4 weeks: 11.2 [SD 10.2], P=.01; 12 weeks: 10.7 [SD 10.2], P<.001) showed gradual improvement; however, no significant differences were found in the mean EQ-5D score (baseline: 0.66 [SD 0.33]; 4 weeks: 0.69 [SD 0.34], P=.01; 12 weeks: 0.69 [SD 0.34], P<.001). Twenty-six patients who had uncontrolled BP at baseline had −13.92 mmHg (P=.001) and −6.19 mmHg (P<.001) reductions on average in systolic and diastolic BP, respectively, without any antihypertensive medication change. Medication compliance was better at visit 2-3 (60.9% [SD 37.2%]) than at visit 1-2 (47.8% [SD 38.7%], P<.001). Conclusions Awareness of stroke, depression, and BP was enhanced when using the smartphone-based mHealth system. Emerging mHealth techniques have potential as new nonpharmacological secondary prevention methods because of their ubiquitous access, near real-time responsiveness, and comparatively lower cost.
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Affiliation(s)
- Do Yeon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Medical Corps, Republic of Korea Navy, Jeju Island, Republic of Korea
| | - Hee Kwon
- LifeSemantics, Corp, Seoul, Republic of Korea
| | - Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yongseok Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Seob Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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15
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Murry LT, Kennelty K. Opportunity for Pharmacists in Telehealth, Team-Based Care: Clinical Inertia. Telemed J E Health 2020; 26:1199-1201. [PMID: 31971882 DOI: 10.1089/tmj.2019.0242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: A variety of team-based telehealth interventions have recently been developed and piloted in a number of practice settings. Despite the variety of intervention designs, clinical inertia (CI) continues to be problematic for therapeutic intensification and subsequent disease control. Commentary: Based on recent literature, pharmacists have the ability to mitigate a number of factors contributing to CI. Considering CI continues to limit overall effectiveness of team-based telehealth interventions, involving pharmacists more intentionally in these interventions would provide benefit to therapeutic intensification and therapeutic outcomes.
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Affiliation(s)
- Logan T Murry
- The University of Iowa College of Pharmacy, Iowa City, Iowa, USA
| | - Korey Kennelty
- The University of Iowa College of Pharmacy, Iowa City, Iowa, USA
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16
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Zhu H, Zheng H, Liu X, Mai W, Huang Y. Clinical applications for out-of-office blood pressure monitoring. Ther Adv Chronic Dis 2020; 11:2040622320901660. [PMID: 32010437 PMCID: PMC6974752 DOI: 10.1177/2040622320901660] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/18/2019] [Indexed: 12/26/2022] Open
Abstract
Hypertension is one of the most common chronic diseases as well as the leading risk factor for cardiovascular disease (CVD). Efficient screening and accurate blood pressure (BP) monitoring are the basic methods of detection and management. However, with developments in electronic technology, BP measurement and monitoring are no longer limited to the physician's office. Epidemiological and clinical studies have documented strong evidence for the efficacy of out-of-office BP monitoring in multiple fields for managing hypertension and CVD. This review discusses applications for out-of-office BP monitoring, including home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), based on recent epidemiological data and clinical studies regarding the following factors: the detection of abnormal BP phenotypes, namely, white coat hypertension and masked hypertension; stronger ability to determine the prognosis for target organ damage and mortality; better BP control; screening for hypotension; and unique approaches to identifying circadian BP patterns and BP variability.
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Affiliation(s)
- Hailan Zhu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Haoxiao Zheng
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Xinyue Liu
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Weiyi Mai
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Jiazi Road 1, Lunjiao Town, Shunde District, Foshan, Guangdong 523808, China
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17
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Santo K, Redfern J. The Potential of mHealth Applications in Improving Resistant Hypertension Self-Assessment, Treatment and Control. Curr Hypertens Rep 2019; 21:81. [PMID: 31598792 DOI: 10.1007/s11906-019-0986-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To review the evidence supporting the use of mobile health (mHealth) apps to improve resistant hypertension self-assessment, treatment and control. RECENT FINDINGS mHealth apps have been used to directly measure blood pressure (BP) levels, either using the oscillometric method with automated inflatable cuffs or using pulse wave signals detected by smartphone technology without the need for cuffs. These app-based BP monitors tend to over or underestimate BP levels when compared to a gold standard aneroid sphygmomanometer. However, the differences in BP measurements are within the acceptable range of 5 mmHg pre-defined by the European Society of Hypertension International Protocol Revision 2010. mHealth apps are also used as tools to support physicians in improving hypertension treatment. App-based clinical decision support systems are innovative solutions, in which patient information is entered in the app and management algorithms provide recommendations for hypertension treatment. The use of these apps has been shown to be feasible and easily integrated into the workflow of healthcare professionals, and, therefore particularly useful in resource-limited settings. In addition, apps can be used to improve hypertension control by facilitating regular BP monitoring, communication between patients and health professionals, and patient education; as well as by reinforcing behaviours through reminders, including medication-taking and appointment reminders. Several studies provided evidence supporting the use of apps for hypertension control. Although some of the results are promising, there is still limited evidence on the benefits of using such mHealth tools, as these studies are relatively small and with a short-term duration. Recent research has shown that mHealth apps can be beneficial in terms of improving hypertension self-assessment, treatment and control, being especially useful to help differentiate and manage true and pseudo-resistant hypertension. However, future research, including large-scale randomised clinical trials with user-centred design, is crucial to further evaluate the potential scalability and effectiveness of such mHealth apps in the resistant hypertension context.
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Affiliation(s)
- Karla Santo
- Academic Research Organization, Hospital Israelita Albert Einstein, São Paulo, Brazil.
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Cardiovascular Division, The George Institute for Global Health, Sydney, Australia.
| | - Julie Redfern
- Westmead Applied Research Centre, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cardiovascular Division, The George Institute for Global Health, Sydney, Australia
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18
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Farid SF. Conceptual Framework of the Impact of Health Technology on Healthcare System. Front Pharmacol 2019; 10:933. [PMID: 31551764 PMCID: PMC6733916 DOI: 10.3389/fphar.2019.00933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 07/22/2019] [Indexed: 01/19/2023] Open
Abstract
The World Health Organization (WHO) promotes health systems strengthening as a means of improving population health, especially in low- and middle-income countries. The United Nations Sustainable Development Goals highlight the importance of investing in workforce development to improve population health and economic well-being. In relation to pharmaceuticals, health systems face challenges in terms of i) guaranteeing access to needed drugs, ii) rationalizing medicines use, and iii) avoiding harm from adverse events. There is a pressing need to better understand the relationships between technology and pharmacy practice when strengthening pharmaceutical care systems. In response, this paper examines ways in which harnessing new technologies can change pharmacy practice and strengthen pharmaceutical systems for the benefit of patients. The paper will present a conceptual framework as well as exploring case studies.
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Affiliation(s)
- Samar F Farid
- Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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19
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Taber DJ, Pilch NA, McGillicuddy JW, Mardis C, Treiber F, Fleming JN. Using informatics and mobile health to improve medication safety monitoring in kidney transplant recipients. Am J Health Syst Pharm 2019; 76:1143-1149. [DOI: 10.1093/ajhp/zxz115] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Purpose
The development, testing, and preliminary validation of a technology-enabled, pharmacist-led intervention aimed at improving medication safety and outcomes in kidney transplant recipients are described.
Summary
Medication safety issues, encompassing medication errors (MEs), medication nonadherence, and adverse drug events (ADEs), are a predominant cause of poor outcomes after kidney transplantation. However, a limited number of clinical trials assessing the effectiveness of technology in improving medication safety and outcomes in transplant recipients have been conducted. Through an iterative, evidence-based approach, a technology-enabled intervention aimed at improving posttransplant medication safety outcomes was developed, tested, and preliminarily validated. Early acceptability and feasibility results from a prospective, randomized controlled trial assessing the effectiveness of this system are reported here. Of the 120 patients enrolled into the trial at the time of writing, 60 were randomly assigned to receive the intervention. At a mean ± S.D. follow-up of 5.8 ± 4.0 months, there were 2 patient dropouts in the intervention group, resulting in a retention rate of 98%, which was higher than the expected 90% retention rate.
Conclusion
The development and deployment of a comprehensive medication safety monitoring dashboard for kidney transplant recipients is feasible and acceptable to patients in the current healthcare environment. An ongoing randomized controlled clinical trial is assessing whether such a system reduces MEs and ADRs, leading to improved patient outcomes.
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Affiliation(s)
- David J Taber
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina
- Department of Pharmacy Services, Ralph H. Johnson VAMC, Charleston, SC
| | - Nicole A Pilch
- Transplant Center, Medical University of South Carolina, and College of Pharmacy, Medical University of South Carolina, Charleston, SC
| | - John W McGillicuddy
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Caitlin Mardis
- College of Pharmacy, University of South Carolina, Columbia, SC
| | - Frank Treiber
- College of Nursing, Medical University of South Carolina, Charleston, SC
| | - James N Fleming
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, and College of Pharmacy, Medical University of South Carolina, Charleston, SC
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20
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Demiris G, Iribarren SJ, Sward K, Lee S, Yang R. Patient generated health data use in clinical practice: A systematic review. Nurs Outlook 2019; 67:311-330. [PMID: 31277895 PMCID: PMC6697140 DOI: 10.1016/j.outlook.2019.04.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/17/2019] [Accepted: 04/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Precision health calls for collecting and analyzing large amounts of data to capture an individual's unique behavior, lifestyle, genetics, and environmental context. The diffusion of digital tools has led to a significant growth of patient generated health data (PGHD), defined as health-related data created, gathered or inferred by or from patients and for which the patient controls data collection and data sharing. PURPOSE We assessed the current evidence of the impact of PGHD use in clinical practice and provide recommendations for the formal integration of PGHD in clinical care. METHODS We searched PubMed, Ovid, Embase, CINAHL, Web of Science, and Scopus up to May 2018. Inclusion criteria were applied and four reviewers screened titles and abstracts and consequently full articles. FINDINGS Our systematic literature review identified 21 studies that examined the use of PGHD in clinical settings. Integration of PGHD into electronic records was extremely limited, and decision support capabilities were for the most part basic. DISCUSSION PGHD and other types of patient-reported data will be part of the health care system narrative and we must continue efforts to understand its impact on health outcomes, costs, and patient satisfaction. Nursing scientists need to lead the process of defining the role of PGHD in the era of precision health.
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Affiliation(s)
- George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, PA.
| | | | | | - Solim Lee
- School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Rumei Yang
- College of Nursing, University of Utah, Salt Lake City, UT
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21
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Abstract
Hypertension and dementia are both common disorders whose prevalence increases with age. There are multiple mechanisms by which hypertension affects the brain and alters cognition. These include blood flow dynamics, development of large and small vessel pathology and diverse molecular mechanisms including formation of reactive oxygen species and transcriptional cascades. Blood pressure interacts with Alzheimer disease pathology in numerous and unpredictable ways, affecting both β-amyloid and tau deposition, while also interacting with AD genetic risk factors and other metabolic processes. Treatment of hypertension may prevent cognitive decline and dementia, but methodological issues have limited the ability of randomized clinical trials to show this conclusively. Recent studies have raised hope that hypertension treatment may protect the function and structure of the aging brain from advancing to mild cognitive impairment and dementia.
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Affiliation(s)
- Nasratullah Wahidi
- Department of Neurology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Alan J Lerner
- Department of Neurology, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
- Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
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22
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Validation of the A&D BP UA-1200BLE device for home blood pressure measurement according to the ISO 81060-2: 2013 standard. Blood Press Monit 2018; 23:312-314. [PMID: 30199378 DOI: 10.1097/mbp.0000000000000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to validate the UA-1200BLE device using the ISO 81060-2:2013 standard. MATERIALS AND METHODS Individuals aged more than 12 years were recruited from among the outpatients and volunteers of Jichi Medical University (Tochigi, Japan). Eighty-five patients were included in the final analyses. Validation was performed using the same-arm sequence protocol as per the ISO 81060-2:2013 standard. RESULTS The device performed well against the standard; the mean and SD values for the differences between device and observed systolic and diastolic blood pressure values fulfilled both criterion 1 and criterion 2 of the standard (criterion 1: -2.62±6.89 and -0.90±6.63 mmHg, respectively; criterion 2: -2.65±5.36 and -0.91±6.12 mmHg, respectively). The Bland-Altman plots did not show any systematic variation in the error. CONCLUSION The UA-1200BLE device had a high level of accuracy and fulfilled all ISO 81060-2:2013 standard requirements in adults with a wide range of arm circumference measurements. It is therefore suitable as a wireless blood pressure monitoring tool in patients with hypertension.
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23
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Thangada ND, Garg N, Pandey A, Kumar N. The Emerging Role of Mobile-Health Applications in the Management of Hypertension. Curr Cardiol Rep 2018; 20:78. [PMID: 30046971 DOI: 10.1007/s11886-018-1022-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Mobile-health technology, frequently referred to as m-health, encompasses smartphone, tablet, or personal computer use in the management of chronic disease. There has been a rise in the number of commercially available smartphone applications and website-based platforms which claim to help patients manage hypertension. Very little research has been performed confirming whether or not use of these applications results in improved blood pressure (BP) outcomes. In this paper, we review existing literature on m-health systems and how m-health can affect hypertension management. RECENT FINDINGS M-health systems help patients manage hypertension in the following ways: (1) setting alarms and reminders for patients to take their medications, (2) linking patients' BP reports to their electronic medical record for their physicians to review, (3) providing feedback to patients about their BP trends, and (4) functioning as point-of-care BP sensors. M-health applications with alarms and reminders can increase medication compliance while applications that share ambulatory BP data with patients' physicians can foster improved patient-physician dialog. However, the most influential tool for achieving positive BP outcomes appears to be patient-directed feedback about BP trends. A large number of commercially available m-health applications may facilitate self-management of hypertension by enhancing medication adherence, maintaining a log of blood pressure measurements, and facilitating physician-patient communication. A small number of applications function as BP sensors, thereby transforming the smartphone into a medical device. Such BP sensors often generate unreliable recordings. Patients must be cautioned regarding the use of smartphones for BP measurement at least until these applications have been more extensively validated.
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Affiliation(s)
- Neela D Thangada
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Neetika Garg
- Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ambarish Pandey
- Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nilay Kumar
- Division of Hospital Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53703, USA.
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