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Sridhar AR, Cheung JW, Lampert R, Silva JNA, Gopinathannair R, Sotomonte JC, Tarakji K, Fellman M, Chrispin J, Varma N, Kabra R, Mehta N, Al-Khatib SM, Mayfield JJ, Navara R, Rajagopalan B, Passman R, Fleureau Y, Shah MJ, Turakhia M, Lakkireddy D. State of the art of mobile health technologies use in clinical arrhythmia care. COMMUNICATIONS MEDICINE 2024; 4:218. [PMID: 39472742 PMCID: PMC11522556 DOI: 10.1038/s43856-024-00618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 09/19/2024] [Indexed: 11/02/2024] Open
Abstract
The rapid growth in consumer-facing mobile and sensor technologies has created tremendous opportunities for patient-driven personalized health management. The diagnosis and management of cardiac arrhythmias are particularly well suited to benefit from these easily accessible consumer health technologies. In particular, smartphone-based and wrist-worn wearable electrocardiogram (ECG) and photoplethysmography (PPG) technology can facilitate relatively inexpensive, long-term rhythm monitoring. Here we review the practical utility of the currently available and emerging mobile health technologies relevant to cardiac arrhythmia care. We discuss the applications of these tools, which vary with respect to diagnostic performance, target populations, and indications. We also highlight that requirements for successful integration into clinical practice require adaptations to regulatory approval, data management, electronic medical record integration, quality oversight, and efforts to minimize the additional burden to health care professionals.
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Affiliation(s)
- Arun R Sridhar
- Cardiac Electrophysiology, Pulse Heart Institute, Multicare Health System, Tacoma, Washington, USA.
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Rachel Lampert
- Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jennifer N A Silva
- Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, USA
| | | | - Juan C Sotomonte
- Cardiovascular Center of Puerto Rico/University of Puerto Rico, San Juan, PR, USA
| | | | | | - Jonathan Chrispin
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rajesh Kabra
- Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Nishaki Mehta
- William Beaumont Oakland University School of Medicine, Rochester, MI, USA
| | - Sana M Al-Khatib
- Division of Cardiology, Duke University Medical Center, Durham, England
| | - Jacob J Mayfield
- Presbyterian Heart Group, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Rachita Navara
- Division of Cardiology, University of California at San Francisco, San Francisco, CA, USA
| | | | - Rod Passman
- Division of Cardiology, Northwestern University School of Medicine, Chicago, IL, USA
| | | | - Maully J Shah
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mintu Turakhia
- Center for Digital Health, Stanford University Stanford, Stanford, CA, USA
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Lüscher TF, Wenzl FA, D'Ascenzo F, Friedman PA, Antoniades C. Artificial intelligence in cardiovascular medicine: clinical applications. Eur Heart J 2024; 45:4291-4304. [PMID: 39158472 DOI: 10.1093/eurheartj/ehae465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/07/2024] [Accepted: 07/03/2024] [Indexed: 08/20/2024] Open
Abstract
Clinical medicine requires the integration of various forms of patient data including demographics, symptom characteristics, electrocardiogram findings, laboratory values, biomarker levels, and imaging studies. Decision-making on the optimal management should be based on a high probability that the envisaged treatment is appropriate, provides benefit, and bears no or little potential harm. To that end, personalized risk-benefit considerations should guide the management of individual patients to achieve optimal results. These basic clinical tasks have become more and more challenging with the massively growing data now available; artificial intelligence and machine learning (AI/ML) can provide assistance for clinicians by obtaining and comprehensively preparing the history of patients, analysing face and voice and other clinical features, by integrating laboratory results, biomarkers, and imaging. Furthermore, AI/ML can provide a comprehensive risk assessment as a basis of optimal acute and chronic care. The clinical usefulness of AI/ML algorithms should be carefully assessed, validated with confirmation datasets before clinical use, and repeatedly re-evaluated as patient phenotypes change. This review provides an overview of the current data revolution that has changed and will continue to change the face of clinical medicine radically, if properly used, to the benefit of physicians and patients alike.
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Affiliation(s)
- Thomas F Lüscher
- Royal Brompton and Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College London, UK
- Cardiovascular Academic Group, King's College, London, UK
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren - Zurich, Switzerland
| | - Florian A Wenzl
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren - Zurich, Switzerland
- National Disease Registration and Analysis Service, NHS, London, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital, Turin, Italy
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
| | - Charalambos Antoniades
- Acute Multidisciplinary Imaging and Interventional Centre, RDM Division of Cardiovascular Medicine, University of Oxford, Headley Way, Headington, Oxford OX39DU, UK
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Varma N, Han JK, Passman R, Rosman LA, Ghanbari H, Noseworthy P, Avari Silva JN, Deshmukh A, Sanders P, Hindricks G, Lip G, Sridhar AR. Promises and Perils of Consumer Mobile Technologies in Cardiovascular Care: JACC Scientific Statement. J Am Coll Cardiol 2024; 83:611-631. [PMID: 38296406 DOI: 10.1016/j.jacc.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 02/08/2024]
Abstract
Direct-to-consumer (D2C) wearables are becoming increasingly popular in cardiovascular health management because of their affordability and capability to capture diverse health data. Wearables may enable continuous health care provider-patient partnerships and reduce the volume of episodic clinic-based care (thereby reducing health care costs). However, challenges arise from the unregulated use of these devices, including questionable data reliability, potential misinterpretation of information, unintended psychological impacts, and an influx of clinically nonactionable data that may overburden the health care system. Further, these technologies could exacerbate, rather than mitigate, health disparities. Experience with wearables in atrial fibrillation underscores these challenges. The prevalent use of D2C wearables necessitates a collaborative approach among stakeholders to ensure effective integration into cardiovascular care. Wearables are heralding innovative disease screening, diagnosis, and management paradigms, expanding therapeutic avenues, and anchoring personalized medicine.
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Affiliation(s)
- Niraj Varma
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Janet K Han
- Department of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Department of Cardiology, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA
| | - Rod Passman
- Department of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lindsey Anne Rosman
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Hamid Ghanbari
- Department of Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Prashanthan Sanders
- Department of Cardiology, University of Adelaide, South Australia, Australia
| | | | - Gregory Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
| | - Arun R Sridhar
- Department of Cardiology, Pulse Heart Institute, Seattle, Washington, USA; Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
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