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Yin X, Huang C, Lin B. Application of intensive management of risk awareness combined with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart failure. Medicine (Baltimore) 2024; 103:e37381. [PMID: 38758887 PMCID: PMC11098228 DOI: 10.1097/md.0000000000037381] [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: 11/29/2023] [Accepted: 02/05/2024] [Indexed: 05/19/2024] Open
Abstract
The aim of this study is to assess the impact of intensive risk awareness management along with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart failure. We selected 101 elderly patients with acute myocardial infarction and heart aging treated from January 2022 to March 2023. They were divided into control and observation groups based on hospitalization numbers. The control group (n = 50) received routine nursing, while the observation group (n = 51) received intensive risk awareness management and cardiac rehabilitation nursing. We compared medication possession ratio (MPR), cardiac function, self-care ability scale scores, quality-of-life, incidents, and satisfaction between the 2 groups. Before intervention, there was no significant difference in MPR values between the 2 groups (P > .05). After intervention, MPR values increased in both groups, with a greater increase in the observation group (P < .05). Cardiac function showed no significant difference before intervention (P > .05), but after intervention, the observation group had lower left ventricular end-systolic and diastolic diameters and higher left ventricular ejection fraction compared to the control group (P < .05). Self-care skills, health knowledge, self-responsibility, and self-concept scores improved in both groups after intervention, with higher scores in the observation group (P < .05). The observation group had higher scores in various quality-of-life domains (P < .05). The total incidence of adverse events was lower in the observation group (5.88%) compared to the control group (20.00%) (P < .05). Patient satisfaction was significantly higher in the observation group (96.08%) than in the control group (84.00%) (P < .05). Intensive risk awareness management combined with cardiac rehabilitation nursing in elderly patients with acute myocardial infarction and heart aging can enhance medication compliance, improve quality-of-life, enhance self-care abilities, boost cardiac function, reduce incidents, and increase patient satisfaction.
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Affiliation(s)
- Xiaoli Yin
- Department of Cardiology, Wannan Rehabilitation Hospital, Wuhu, Anhui, China
| | - Cuiping Huang
- Department of Cardiology, Wannan Rehabilitation Hospital, Wuhu, Anhui, China
| | - Binglai Lin
- Department of Cardiology, Wannan Rehabilitation Hospital, Wuhu, Anhui, China
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Commodore-Mensah Y, Chen Y, Ogungbe O, Liu X, Metlock FE, Carson KA, Echouffo-Tcheugui JB, Ibe C, Crews D, Cooper LA, Himmelfarb CD. Design and Rationale of the Cardiometabolic Health Program Linked with Community Health Workers and Mobile Health Telemonitoring to Reduce Health DisparitieS (LINKED-HEARTS) Program. Am Heart J 2024:S0002-8703(24)00123-6. [PMID: 38759910 DOI: 10.1016/j.ahj.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Hypertension and diabetes are major risk factors for cardiovascular diseases, stroke, and chronic kidney disease (CKD). Disparities in hypertension control persist among Black and Hispanic adults and persons living in poverty in the United States. The "LINKED-HEARTS Program" (a Cardiometabolic Health Program LINKED with Community Health WorkErs and Mobile HeAlth TelemonitoRing To reduce Health DisparitieS"), is a multi-level intervention that includes home blood pressure (BP) monitoring (HBPM), blood glucose telemonitoring, and team-based care. This study aims to examine the effect of the LINKED-HEARTS Program intervention in improving BP control compared to enhanced usual care (EUC) and to evaluate the reach, adoption, sustainability, and cost-effectiveness of the program. METHODS Using a hybrid type I effectiveness-implementation design, 428 adults with uncontrolled hypertension (systolic BP ≥ 140 mm Hg) and diabetes or CKD will be recruited from 18 primary care practices, including community health centers, in Maryland. Using a cluster-randomized trial design, practices are randomly assigned to the LINKED-HEARTS intervention arm or EUC arm. Participants in the LINKED-HEARTS intervention arm receive training on HBPM, BP and glucose telemonitoring, and community health worker and pharmacist telehealth visits on lifestyle modification and medication management over 12 months. The primary outcome is the proportion of participants with controlled BP (<140/90 mm Hg) at 12 months. CONCLUSIONS The study tests a multi-level intervention to control multiple chronic diseases. Findings from the study may be leveraged to reduce disparities in the management and control of chronic diseases and make primary care more responsive to the needs of underserved populations.
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Affiliation(s)
- Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing; Johns Hopkins University Bloomberg School of Public Health
| | | | | | | | | | - Kathryn A Carson
- Johns Hopkins University Bloomberg School of Public Health; Johns Hopkins University School of Medicine
| | | | | | - Deidra Crews
- Johns Hopkins University School of Medicine; Johns Hopkins University Medical Institutions
| | - Lisa A Cooper
- Johns Hopkins University Bloomberg School of Public Health; Johns Hopkins University School of Medicine
| | - Cheryl Dennison Himmelfarb
- Johns Hopkins University School of Nursing; Johns Hopkins University Bloomberg School of Public Health; Johns Hopkins University School of Medicine.
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3
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Avoke D, Elshafeey A, Weinstein R, Kim CH, Martin SS. Digital Health in Diabetes and Cardiovascular Disease. Endocr Res 2024:1-13. [PMID: 38605594 DOI: 10.1080/07435800.2024.2341146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Digital health technologies are rapidly evolving and transforming the care of diabetes and cardiovascular disease (CVD). PURPOSE OF THE REVIEW In this review, we discuss emerging approaches incorporating digital health technologies to improve patient outcomes through a more continuous, accessible, proactive, and patient-centered approach. We discuss various mechanisms of potential benefit ranging from early detection to enhanced physiologic monitoring over time to helping shape important management decisions and engaging patients in their care. Furthermore, we discuss the potential for better individualization of management, which is particularly important in diseases with heterogeneous and complex manifestations, such as diabetes and cardiovascular disease. This narrative review explores ways to leverage digital health technology to better extend the reach of clinicians beyond the physical hospital and clinic spaces to address disparities in the diagnosis, treatment, and prevention of diabetes and cardiovascular disease. CONCLUSION We are at the early stages of the shift to digital medicine, which holds substantial promise not only to improve patient outcomes but also to lower the costs of care. The review concludes by recognizing the challenges and limitations that need to be addressed for optimal implementation and impact. We present recommendations on how to navigate these challenges as well as goals and opportunities in utilizing digital health technology in the management of diabetes and prevention of adverse cardiovascular outcomes.
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Affiliation(s)
- Dorothy Avoke
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Robert Weinstein
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chang H Kim
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth S Martin
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Katz ME, Mszar R, Grimshaw AA, Gunderson CG, Onuma OK, Lu Y, Spatz ES. Digital Health Interventions for Hypertension Management in US Populations Experiencing Health Disparities: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2356070. [PMID: 38353950 PMCID: PMC10867699 DOI: 10.1001/jamanetworkopen.2023.56070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/21/2023] [Indexed: 02/16/2024] Open
Abstract
Importance Hypertension remains a leading factor associated with cardiovascular disease, and demographic and socioeconomic disparities in blood pressure (BP) control persist. While advances in digital health technologies have increased individuals' access to care for hypertension, few studies have analyzed the use of digital health interventions in vulnerable populations. Objective To assess the association between digital health interventions and changes in BP and to characterize tailored strategies for populations experiencing health disparities. Data Sources In this systematic review and meta-analysis, a systematic search identified studies evaluating digital health interventions for BP management in the Cochrane Library, Ovid Embase, Google Scholar, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases from inception until October 30, 2023. Study Selection Included studies were randomized clinical trials or cohort studies that investigated digital health interventions for managing hypertension in adults; presented change in systolic BP (SBP) or baseline and follow-up SBP levels; and emphasized social determinants of health and/or health disparities, including a focus on marginalized populations that have historically been underserved or digital health interventions that were culturally or linguistically tailored to a population with health disparities. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Data Extraction and Synthesis Two reviewers extracted and verified data. Mean differences in BP between treatment and control groups were analyzed using a random-effects model. Main Outcomes and Measures Primary outcomes included mean differences (95% CIs) in SBP and diastolic BP (DBP) from baseline to 6 and 12 months of follow-up between digital health intervention and control groups. Shorter- and longer-term follow-up durations were also assessed, and sensitivity analyses accounted for baseline BP levels. Results A total of 28 studies (representing 8257 participants) were included (overall mean participant age, 57.4 years [range, 46-71 years]; 4962 [60.1%], female). Most studies examined multicomponent digital health interventions incorporating remote BP monitoring (18 [64.3%]), community health workers or skilled nurses (13 [46.4%]), and/or cultural tailoring (21 [75.0%]). Sociodemographic characteristics were similar between intervention and control groups. Between the intervention and control groups, there were statistically significant mean differences in SBP at 6 months (-4.24 mm Hg; 95% CI, -7.33 to -1.14 mm Hg; P = .01) and SBP changes at 12 months (-4.30 mm Hg; 95% CI, -8.38 to -0.23 mm Hg; P = .04). Few studies (4 [14.3%]) reported BP changes and hypertension control beyond 1 year. Conclusions and Relevance In this systematic review and meta-analysis of digital health interventions for hypertension management in populations experiencing health disparities, BP reductions were greater in the intervention groups compared with the standard care groups. The findings suggest that tailored initiatives that leverage digital health may have the potential to advance equity in hypertension outcomes.
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Affiliation(s)
| | - Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Alyssa A. Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut
| | - Craig G. Gunderson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- VA Connecticut Healthcare System, West Haven
| | - Oyere K. Onuma
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Yuan Lu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
| | - Erica S. Spatz
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Yale Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
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Babu M, Lautman Z, Lin X, Sobota MHB, Snyder MP. Wearable Devices: Implications for Precision Medicine and the Future of Health Care. Annu Rev Med 2024; 75:401-415. [PMID: 37983384 DOI: 10.1146/annurev-med-052422-020437] [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] [Indexed: 11/22/2023]
Abstract
Wearable devices are integrated analytical units equipped with sensitive physical, chemical, and biological sensors capable of noninvasive and continuous monitoring of vital physiological parameters. Recent advances in disciplines including electronics, computation, and material science have resulted in affordable and highly sensitive wearable devices that are routinely used for tracking and managing health and well-being. Combined with longitudinal monitoring of physiological parameters, wearables are poised to transform the early detection, diagnosis, and treatment/management of a range of clinical conditions. Smartwatches are the most commonly used wearable devices and have already demonstrated valuable biomedical potential in detecting clinical conditions such as arrhythmias, Lyme disease, inflammation, and, more recently, COVID-19 infection. Despite significant clinical promise shown in research settings, there remain major hurdles in translating the medical uses of wearables to the clinic. There is a clear need for more effective collaboration among stakeholders, including users, data scientists, clinicians, payers, and governments, to improve device security, user privacy, data standardization, regulatory approval, and clinical validity. This review examines the potential of wearables to offer affordable and reliable measures of physiological status that are on par with FDA-approved specialized medical devices. We briefly examine studies where wearables proved critical for the early detection of acute and chronic clinical conditions with a particular focus on cardiovascular disease, viral infections, and mental health. Finally, we discuss current obstacles to the clinical implementation of wearables and provide perspectives on their potential to deliver increasingly personalized proactive health care across a wide variety of conditions.
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Affiliation(s)
- Mohan Babu
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Ziv Lautman
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
- Department of Bioengineering, Stanford University School of Medicine, Stanford, California, USA
| | - Xiangping Lin
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Milan H B Sobota
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
| | - Michael P Snyder
- Department of Genetics, Stanford University School of Medicine, Stanford, California, USA;
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Spatz ES, Ginsburg GS, Rumsfeld JS, Turakhia MP. Wearable Digital Health Technologies for Monitoring in Cardiovascular Medicine. N Engl J Med 2024; 390:346-356. [PMID: 38265646 DOI: 10.1056/nejmra2301903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Erica S Spatz
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
| | - Geoffrey S Ginsburg
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
| | - John S Rumsfeld
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
| | - Mintu P Turakhia
- From the Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (E.S.S.); the National Institutes of Health, Bethesda, MD (G.S.G.); the University of Colorado School of Medicine, Aurora (J.S.R.); and Meta Platforms, Menlo Park (J.S.R.), the Stanford Center for Digital Health, Stanford University School of Medicine, Stanford (M.P.T.), and iRhythm Technologies, San Francisco (M.P.T.) - all in California
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7
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Isakadze N, Kim CH, Marvel FA, Ding J, MacFarlane Z, Gao Y, Spaulding EM, Stewart KJ, Nimbalkar M, Bush A, Broderick A, Gallagher J, Molello N, Commodore-Mensah Y, Michos ED, Dunn P, Hanley DF, McBee N, Martin SS, Mathews L. Rationale and Design of the mTECH-Rehab Randomized Controlled Trial: Impact of a Mobile Technology Enabled Corrie Cardiac Rehabilitation Program on Functional Status and Cardiovascular Health. J Am Heart Assoc 2024; 13:e030654. [PMID: 38226511 PMCID: PMC10926786 DOI: 10.1161/jaha.123.030654] [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: 04/20/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Cardiac rehabilitation (CR) is an evidence-based, guideline-recommended intervention for patients recovering from a cardiac event, surgery or procedure that improves morbidity, mortality, and functional status. CR is traditionally provided in-center, which limits access and engagement, most notably among underrepresented racial and ethnic groups due to barriers including cost, scheduling, and transportation access. This study is designed to evaluate the Corrie Hybrid CR, a technology-based, multicomponent health equity-focused intervention as an alternative to traditional in-center CR among patients recovering from a cardiac event, surgery, or procedure compared with usual care alone. METHODS The mTECH-Rehab (Impact of a Mobile Technology Enabled Corrie CR Program) trial will randomize 200 patients who either have diagnosis of myocardial infarction or who undergo coronary artery bypass grafting surgery, percutaneous coronary intervention, heart valve repair, or replacement presenting to 4 hospitals in a large academic health system in Maryland, United States, to the Corrie Hybrid CR program combined with usual care CR (intervention group) or usual care CR alone (control group) in a parallel arm, randomized controlled trial. The Corrie Hybrid CR program leverages 5 components: (1) a patient-facing mobile application that encourages behavior change, patient empowerment, and engagement with guideline-directed therapy; (2) Food and Drug Administration-approved smart devices that collect health metrics; (3) 2 upfront in-center CR sessions to facilitate personalization, self-efficacy, and evaluation for the safety of home exercise, followed by a combination of in-center and home-based sessions per participant preference; (4) a clinician dashboard to track health data; and (5) weekly virtual coaching sessions delivered over 12 weeks for education, encouragement, and risk factor modification. The primary outcome is the mean difference between the intervention versus control groups in distance walked on the 6-minute walk test (ie, functional capacity) at 12 weeks post randomization. Key secondary and exploratory outcomes include improvement in a composite cardiovascular health metric, CR engagement, quality of life, health factors (including low-density lipoprotein-cholesterol, hemoglobin A1c, weight, diet, smoking cessation, blood pressure), and psychosocial factors. Approval for the study was granted by the local institutional review board. Results of the trial will be published once data collection and analysis have been completed. CONCLUSIONS The Corrie Hybrid CR program has the potential to improve functional status, cardiovascular health, and CR engagement and advance equity in access to cardiac rehabilitation. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05238103.
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Affiliation(s)
- Nino Isakadze
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Chang H Kim
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Francoise A Marvel
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Jie Ding
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Zane MacFarlane
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Yumin Gao
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Erin M Spaulding
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
- Johns Hopkins University School of Nursing Baltimore MD USA
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD USA
| | - Kerry J Stewart
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Mansi Nimbalkar
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Alexandra Bush
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Ashley Broderick
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Jeanmarie Gallagher
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Nancy Molello
- Johns Hopkins Center for Health Equity Baltimore MD USA
| | - Yvonne Commodore-Mensah
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
- Johns Hopkins University School of Nursing Baltimore MD USA
- Johns Hopkins Center for Health Equity Baltimore MD USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
| | - Patrick Dunn
- Center for Health Technology and Innovation, American Heart Association Dallas TX USA
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA
| | - Daniel F Hanley
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA
- Division of Neurosurgery, Department of Surgery Johns Hopkins University School of Medicine Baltimore MD USA
- Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore MD USA
| | - Nichol McBee
- Ginsburg Institute for Health Equity, Nemours Children's Health Orlando FL USA
- Department of Neurology Johns Hopkins University School of Medicine Baltimore MD USA
| | - Seth S Martin
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
- Johns Hopkins Center for Health Equity Baltimore MD USA
| | - Lena Mathews
- Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine Johns Hopkins University School of Medicine Baltimore MD USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH Center) Baltimore MD USA
- Johns Hopkins Center for Health Equity Baltimore MD USA
- Welch Center for Prevention, Epidemiology, and Clinical Research Johns Hopkins University Baltimore MD USA
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Chong SOK, Pedron S, Abdelmalak N, Laxy M, Stephan AJ. An umbrella review of effectiveness and efficacy trials for app-based health interventions. NPJ Digit Med 2023; 6:233. [PMID: 38104213 PMCID: PMC10725431 DOI: 10.1038/s41746-023-00981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023] Open
Abstract
Health interventions based on mobile phone or tablet applications (apps) are promising tools to help patients manage their conditions more effectively. Evidence from randomized controlled trials (RCTs) on efficacy and effectiveness of such interventions is increasingly available. This umbrella review aimed at mapping and narratively summarizing published systematic reviews on efficacy and effectiveness of mobile app-based health interventions within patient populations. We followed a pre-specified publicly available protocol. Systematic reviews were searched in two databases from inception until August 28, 2023. Reviews that included RCTs evaluating integrated or stand-alone health app interventions in patient populations with regard to efficacy/effectiveness were considered eligible. Information on indications, outcomes, app characteristics, efficacy/effectiveness results and authors' conclusions was extracted. Methodological quality was assessed using the AMSTAR2 tool. We identified 48 systematic reviews published between 2013 and 2023 (35 with meta-analyses) that met our inclusion criteria. Eleven reviews included a broad spectrum of conditions, thirteen focused on diabetes, five on anxiety and/or depression, and others on various other indications. Reported outcomes ranged from medication adherence to laboratory, anthropometric and functional parameters, symptom scores and quality of life. Fourty-one reviews concluded that health apps may be effective in improving health outcomes. We rated one review as moderate quality. Here we report that the synthesized evidence on health app effectiveness varies largely between indications. Future RCTs should consider reporting behavioral (process) outcomes and measures of healthcare resource utilization to provide deeper insights on mechanisms that make health apps effective, and further elucidate their impact on healthcare systems.
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Affiliation(s)
- Sherry On Ki Chong
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - Sara Pedron
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Nancy Abdelmalak
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Michael Laxy
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Anna-Janina Stephan
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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de Moel-Mandel C, Lynch C, Issaka A, Braver J, Zisis G, Carrington MJ, Oldenburg B. Optimising the implementation of digital-supported interventions for the secondary prevention of heart disease: a systematic review using the RE-AIM planning and evaluation framework. BMC Health Serv Res 2023; 23:1347. [PMID: 38049862 PMCID: PMC10694952 DOI: 10.1186/s12913-023-10361-6] [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: 10/12/2023] [Accepted: 11/22/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND mHealth technologies are now widely utilised to support the delivery of secondary prevention programs in heart disease. Interventions with mHealth included have shown a similar efficacy and safety to conventional programs with improvements in access and adherence. However, questions remain regarding the successful wider implementation of digital-supported programs. By applying the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to a systematic review and meta-analysis, this review aims to evaluate the extent to which these programs report on RE-AIM dimensions and associated indicators. METHODS This review extends our previous systematic review and meta-analysis that investigated the effectiveness of digital-supported programs for patients with coronary artery disease. Citation searches were performed on the 27 studies of the systematic review to identify linked publications that reported data for RE-AIM dimensions. All included studies and, where relevant, any additional publications, were coded using an adapted RE-AIM extraction tool. Discrepant codes were discussed amongst reviewers to gain consensus. Data were analysed to assess reporting on indicators related to each of the RE-AIM dimensions, and average overall reporting rates for each dimension were calculated. RESULTS Searches found an additional nine publications. Across 36 publications that were linked to the 27 studies, 24 (89%) of the studies were interventions solely delivered at home. The average reporting rates for RE-AIM dimensions were highest for effectiveness (75%) and reach (67%), followed by adoption (54%), implementation (36%) and maintenance (11%). Eleven (46%) studies did not describe relevant characteristics of their participants or of staff involved in the intervention; most studies did not describe unanticipated consequences of the intervention; the ongoing cost of intervention implementation and maintenance; information on intervention fidelity; long-term follow-up outcomes, or program adaptation in other settings. CONCLUSIONS Through the application of the RE-AIM framework to a systematic review we found most studies failed to report on key indicators. Failing to report these indicators inhibits the ability to address the enablers and barriers required to achieve optimal intervention implementation in wider settings and populations. Future studies should consider alternative hybrid trial designs to enable reporting of implementation indicators to improve the translation of research evidence into routine practice, with special consideration given to the long-term sustainability of program effects as well as corresponding ongoing costs. REGISTRATION PROSPERO-CRD42022343030.
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Affiliation(s)
| | - Chris Lynch
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia.
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia.
- Northern Health, Melbourne, VIC, Australia.
| | - Ayuba Issaka
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
| | - Justin Braver
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Georgios Zisis
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Northern Health, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
- Western Health, Melbourne, VIC, Australia
| | - Brian Oldenburg
- School of Psychology & Public Health, La Trobe University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne, VIC, Australia
- Northern Health, Melbourne, VIC, Australia
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10
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Kaplan A, Boivin M, Bouchard J, Kim J, Hayes S, Licskai C. The emerging role of digital health in the management of asthma. Ther Adv Chronic Dis 2023; 14:20406223231209329. [PMID: 38028951 PMCID: PMC10657529 DOI: 10.1177/20406223231209329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
The most common reasons seen for lack of asthma control include misconceptions about disease control, low controller treatment adherence, poor inhaler technique, and the resulting underuse of controllers and overuse of short-acting beta2 agonists (SABAs). Narrowing these care gaps may be achieved through well-designed patient education that considers the patient's motivation, beliefs, and capabilities regarding their asthma and its management and empowers the patient to become an active participant in treatment decisions. Digital health technologies (DHTs) and digital therapeutic (DT) devices provide new opportunities to monitor treatment behaviors, improve communication between healthcare providers and patients, and generate data that inform educational interactions. DHT and DT have been proven effective in enhancing patient self-management in other chronic conditions, particularly diabetes. Accelerated integration of DHT and DT into the management of asthma patients is facilitated by the use of digital inhalers that employ sensor technology ("smart" inhalers). These devices efficiently provide real-time feedback on controller adherence, SABA use, and inhaler technique that have the strong potential to optimize asthma control.
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Affiliation(s)
- Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, 14872 Yonge Street, Aurora, Toronto, ON L4G 1N2, Canada
- Family Physician Airways Group of Canada, Markham, ON, Canada
| | | | | | - James Kim
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Christopher Licskai
- Division of Respirology, Department of Medicine, Western University, London, ON, Canada
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11
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Gibson I, Jennings C, Neubeck L, Corcoran M, Wood D, Sharif F, Hynes L, Murphy AW, Byrne M, McEvoy JW. Using a digital health intervention "INTERCEPT" to improve secondary prevention in coronary heart disease (CHD) patients: protocol for a mixed methods non-randomised feasibility study. HRB Open Res 2023; 6:43. [PMID: 38414839 PMCID: PMC10897504 DOI: 10.12688/hrbopenres.13781.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 02/29/2024] Open
Abstract
Background: Digital health interventions (DHIs) are increasingly used for the secondary prevention of cardiovascular disease (CVD). The aim of this study is to determine the feasibility of "INTERCEPT", a co-designed DHI developed to improve secondary prevention in hospitalised coronary heart disease patients (CHD). Methods: This non-randomised feasibility study will be conducted using a mixed methods process evaluation with a sample of 40 patients in an acute hospital setting. Informed by behaviour change theory, the Intercept application (I-App) integrates a smartphone interface, health care professional portal, a fitness wearable and a blood pressure monitor. I-App is designed to support and motivate patients to set goals, self-monitor lifestyle and medical risk factors, and manage their medications, with the health care professional portal enabling monitoring and communication with patients. Using convenience sampling, eligible patients will be recruited in two phases, a pre-implementation phase and an implementation phase. During the pre-implementation phase participants will not immediately receive the I-App but will be invited to receive the I-App at 3 months follow-up. This will enable early learning about the processes of recruitment and conducting the assessment prior to full scale deployment of the I-App. During the implementation phase, participants will be invited to download the I-App to their smartphone prior to hospital discharge. Qualitative interviews will be conducted among a subset of patients and health care professionals to gain a greater insight into their experience of using the I-App. Primary outcomes will be assessed at baseline and 3-month follow-up. Using pre-defined feasibility criteria, including recruitment, retention and engagement rates, together with data on intervention acceptability, will determine the appropriateness of progressing to a definitive trial. Discussion: This study will provide important insights to help inform the feasibility of conducting a definitive trial of "INTERCEPT" among coronary heart disease patients in a critical health care setting.
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Affiliation(s)
- Irene Gibson
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Catriona Jennings
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - David Wood
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Faisal Sharif
- School of Medicine, University of Galway, Galway, Ireland
| | - Lisa Hynes
- Croí, West of Ireland Cardiac Foundation, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, University of Galway, Galway, Ireland
| | - John William McEvoy
- School of Medicine, University of Galway, Galway, Ireland
- National Institute for Prevention and Cardiovascular Health, Galway, Ireland
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12
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Garrels E, Kainth T, Silva B, Yadav G, Gill G, Salehi M, Gunturu S. Pathophysiological mechanisms of post-myocardial infarction depression: a narrative review. Front Psychiatry 2023; 14:1225794. [PMID: 37599890 PMCID: PMC10436342 DOI: 10.3389/fpsyt.2023.1225794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Myocardial infarction (MI) can have significant physical and mental consequences. Depression is a prevalent psychiatric condition after MI which can reduce the quality of life and increase the mortality rates of patients. However, the connection between MI and depression has remained under-appreciated. This review examines the potential connection between depression and MI by overviewing the possible pathophysiologic mechanisms including dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, coagulation system dysfunction, inflammation, environmental factors, as well as, genetic factors. Furthermore, depression can be an adverse event of medications used for MI treatment including beta-blockers, statins, or anti-platelet agents. The need for early detection and management of depression in patients with MI is, therefore, crucial for improving their overall prognosis. Adherence to treatments and regular follow-up visits can ensure the best response to treatment.
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Affiliation(s)
- Eric Garrels
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
| | - Tejasvi Kainth
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
| | - Briana Silva
- BronxCare Health System, New York, NY, United States
| | - Garima Yadav
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
| | - Gurtej Gill
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
| | - Mona Salehi
- BronxCare Health System, New York, NY, United States
| | - Sasidhar Gunturu
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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13
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Golbus JR. Mobile Health Technology: (Smart)Watch and Wait. JACC Case Rep 2023; 17:101898. [PMID: 37496725 PMCID: PMC10366495 DOI: 10.1016/j.jaccas.2023.101898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Jessica R. Golbus
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
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14
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Düsing P, Eckardt I, Schirmer SH, Sinning JM, Werner N, Bönner F, Krogmann A, Schäfer S, Sedaghat A, Müller C, Nickenig G, Zietzer A. A prospective, randomized, controlled, multicentre trial for secondary prevention in patients with chronic coronary syndrome using a smartphone application for digital therapy: the CHANGE study protocol. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:207-215. [PMID: 37265862 PMCID: PMC10232292 DOI: 10.1093/ehjdh/ztad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/16/2023] [Indexed: 06/03/2023]
Abstract
Aims Coronary artery disease (CAD) remains the leading cause of death worldwide. 'Stable' CAD is a chronic progressive condition, which recent European guidelines recommend referring to as 'chronic coronary syndrome' (CCS). Despite therapeutic advances, morbidity and mortality among patients with CCS remain high. Optimal secondary prevention in patients with CCS includes optimization of modifiable risk factors with behavioural changes and pharmacological therapy. The CHANGE study aims to provide evidence for optimization of secondary prevention in CCS patients by using a smartphone application (app). Methods and results The CHANGE study is designed as a prospective, randomized, controlled trial with a 1:1 allocation ratio, which is currently performed in nine centres in Germany in a parallel group design. 210 patients with CCS will be randomly allocated either to the control group (standard-of-care) or to the intervention group, who will be provided the VantisTherapy* app in addition to standard-of-care to incorporate secondary prevention into their daily life. The study will be performed in an open design. Outcomes will be assessed using objective data from three in-person visits (0, 12, and 24 weeks). Primary outcomes will involve adherence to secondary prevention recommendations and quality of life (QoL). The recruitment process started in July 2022. Conclusion The CHANGE study will investigate whether a smartphone-guided secondary prevention app, combined with a monitor function compared with standard-of-care, has beneficial effects on overall adherence to secondary prevention guidelines and QoL in patients with CCS. Trial registration The study is listed at the German study registry (DRKS) under the registered number DRKS00028081.
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Affiliation(s)
| | | | | | - Jan-Malte Sinning
- Department of Cardiology, St. Vinzenz Hospital Cologne, Mehrheimer Str. 221-223, 50733 Cologne, Germany
| | - Nikos Werner
- Medical Department III, Heart Center Trier, Krankenhaus der Barmherzigen Brüder, Nordallee 1, 54292 Trier, Germany
| | - Florian Bönner
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty of Heinrich Heine University, University Hospital Düsseldorf, Moorenstr 5, 40225 Düsseldorf, Germany
| | - Alexander Krogmann
- Kardio-Lev, Kardiologische Gemeinschaftspraxis Dr. P. Son, Dr. M. Päsler, Dr. A. Krogmann, Friedrich-Ebert-Str. 17, 51373 Leverkusen, Germany
| | - Sebastian Schäfer
- Praxis Rheingalerie Rodenkirchen, Hauptstr 39-41, 50996 Cologne, Germany
| | - Alexander Sedaghat
- Rhein-Ahr-Cardio, Praxis für Kardiologie, Wilhelmstr 14, 53474 Bad Neuenahr-Ahrweiler, Germany
| | - Cornelius Müller
- Kardio Bonn, Gemeinschaftspraxis Dr. La Rosée & Prof. Müller, Baumschulallee 1, 53115 Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Andreas Zietzer
- Corresponding author. Tel: +49 228 287-51485, Fax: +49 228 287-51489,
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15
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Koyawala N, Mathews LM, Marvel FA, Martin SS, Blumenthal RS, Sharma G. A clinician's guide to addressing cardiovascular health based on a revised AHA framework. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2023; 13:52-58. [PMID: 37213316 PMCID: PMC10193249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/10/2023] [Indexed: 05/23/2023]
Abstract
The American Heart Association recently published updates to its definition of cardiovascular health (CVH) in its Presidential Advisory called Life's Essential 8. In particular, the update from Life's Simple 7 added a new component of sleep duration and refined definitions of prior components, including measurement of diet, nicotine exposure, blood lipids, and blood glucose. Physical activity, BMI, and blood pressure were unchanged. Together, these eight components create a composite CVH score that clinicians, policy-makers, patients, communities, and businesses can utilize to communicate in a consistent way. Life's Essential 8 also emphasizes the critical role of addressing social determinants of health to improve these individual CVH components, which strongly correlate with future cardiovascular outcomes. This framework should be used across the life spectrum including during pregnancy and childhood to allow improvements in and prevention of CVH at critical time-points. Clinicians can use this framework to advocate for digital health technologies and societal policies that help address and more seamlessly measure the 8 components of CVH with the goal of increasing quality and quantity of life.
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Affiliation(s)
- Neel Koyawala
- Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
| | - Lena M Mathews
- Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- The Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH), Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
| | - Francoise A Marvel
- Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- The Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH), Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
| | - Seth S Martin
- Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- The Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- Center for Mobile Technologies to Achieve Equity in Cardiovascular Health (mTECH), Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
| | - Roger S Blumenthal
- Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- The Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
| | - Garima Sharma
- Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
- The Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of MedicineBaltimore 21287, MD, USA
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16
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Seneviratne MG, Connolly SB, Martin SS, Parakh K. Grains of Sand to Clinical Pearls: Realizing the Potential of Wearable Data. Am J Med 2023; 136:136-142. [PMID: 36351523 DOI: 10.1016/j.amjmed.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
Despite the rapid growth of wearables as a consumer technology sector and a growing evidence base supporting their use, they have been slow to be adopted by the health system into clinical care. As regulatory, reimbursement, and technical barriers recede, a persistent challenge remains how to make wearable data actionable for clinicians-transforming disconnected grains of wearable data into meaningful clinical "pearls". In order to bridge this adoption gap, wearable data must become visible, interpretable, and actionable for the clinician. We showcase emerging trends and best practices that illustrate these 3 pillars, and offer some recommendations on how the ecosystem can move forward.
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Affiliation(s)
| | | | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins, Baltimore, MD
| | - Kapil Parakh
- Google Research, Washington, DC; Georgetown School of Medicine, Washington, DC
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17
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Şaylık F, Çınar T, İlker Hayıroğlu M, İlker Tekkeşin A. Digital Health Interventions in Patient Management Following Acute Coronary Syndrome: A Meta-Analysis of the Literature. Anatol J Cardiol 2023; 27:2-9. [PMID: 36680440 PMCID: PMC9893709 DOI: 10.14744/anatoljcardiol.2022.2254] [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: 06/23/2022] [Accepted: 09/02/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Acute coronary syndrome patients should be closely followed-up to maintain optimal adherence to medical treatments and to reduce adverse events. Digital health interventions might provide improved outcomes for patient care by providing closer follow- up, compared to standard care. Thus, in this meta-analysis, we aimed to evaluate the effect of digital health interventions on follow-up in acute coronary syndrome patients. METHODS We searched medical databases to obtain all relevant studies comparing digital health interventions with standard care in acute coronary syndrome patients. After reviewing all eligible studies, a meta-analysis was conducted with the remaining 11 randomized controlled studies and 2 non-randomized controlled studies. A modified Jadad scale and Newcastle-Ottawa scale were used to assess the quality of the publications for randomized controlled studies and non-randomized controlled studies, respectively. RESULTS This meta-analysis consisted of 7657 patients. The all-cause mortality rate was 49% lower in the digital health intervention cases, compared to those who received standard care [relative risk (RR) = 0.51 (0.37; 0.70), P <.01]. There was a significant decrease in systolic blood pressure in the digital health interventions group, compared to the standard care group [mean difference = -5.28 (-9.47; -1.08), P =.01]. The rate of nonadherence to anti-aggregant drugs was 69% lower in the digital health interventions than in the standard care group [RR = 0.31 (0.20; 0.46), P <.01]. Also, nonadherence rates for statin and beta-blockers were lower in the digital health interventions group. The risk of rehospitalization was observed to be 55% less in the digital health interventions patients, compared to the standard care group [RR = 0.45 (0.30; 0.67), P <.01]. CONCLUSION Digital health interventions can be effective in follow-up for secondary prevention in acute coronary syndrome patients.
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Affiliation(s)
- Faysal Şaylık
- Department of Cardiology, Van Training and Research Hospital, Van, Turkey
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | | | - Mert İlker Hayıroğlu
- Department of Cardiology, Van Training and Research Hospital, Van, Turkey
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Ahmet İlker Tekkeşin
- Department of Cardiology, Van Training and Research Hospital, Van, Turkey
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, İstanbul, Turkey
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
- Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
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18
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Whiwon L, Salma S, Daniel A, Stephanie L, Marc C, Cherith S, Abby T, Angela S, Robin H, Yvonne B. Patient-facing digital tools for delivering genetic services: a systematic review. J Med Genet 2023; 60:1-10. [PMID: 36137613 DOI: 10.1136/jmg-2022-108653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
This study systematically reviewed the literature on the impact of digital genetics tools on patient care and system efficiencies. MEDLINE and Embase were searched for articles published between January 2010 and March 2021. Studies evaluating the use of patient-facing digital tools in the context of genetic service delivery were included. Two reviewers screened and extracted patient-reported and system-focused outcomes from each study. Data were synthesised using a descriptive approach. Of 3226 unique studies identified, 87 were included. A total of 70 unique digital tools were identified. As a result of using digital tools, 84% of studies reported a positive outcome in at least one of the following patient outcomes: knowledge, psychosocial well-being, behavioural/management changes, family communication, decision-making or level of engagement. Digital tools improved workflow and efficiency for providers and reduced the amount of time they needed to spend with patients. However, we identified a misalignment between study purpose and patient-reported outcomes measured and a lack of tools that encompass the entire genetic counselling and testing trajectory. Given increased demand for genetic services and the shift towards virtual care, this review provides evidence that digital tools can be used to efficiently deliver patient-centred care. Future research should prioritise development, evaluation and implementation of digital tools that can support the entire patient trajectory across a range of clinical settings. PROSPERO registration numberCRD42020202862.
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Affiliation(s)
- Lee Whiwon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shickh Salma
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Assamad Daniel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Luca Stephanie
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Clausen Marc
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Somerville Cherith
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tafler Abby
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shaw Angela
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Hayeems Robin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Bombard Yvonne
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Genomics Health Services Research Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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19
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Maddula R, MacLeod J, McLeish T, Painter S, Steward A, Berman G, Hamid A, Abdelrahim M, Whittle J, Brown SA. The role of digital health in the cardiovascular learning healthcare system. Front Cardiovasc Med 2022; 9:1008575. [PMID: 36407438 PMCID: PMC9668874 DOI: 10.3389/fcvm.2022.1008575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - James MacLeod
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Tyson McLeish
- Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sabrina Painter
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
| | - Austin Steward
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | | | | | - Jeffrey Whittle
- Division of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Sherry Ann Brown
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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20
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West NEJ, Juneja M, Pinilla N, De Loose KR, Henry TD, Baumgard CS, Kraineva O. Personalized vascular healthcare: insights from a large international survey. Eur Heart J Suppl 2022; 24:H8-H17. [PMID: 36382003 PMCID: PMC9650465 DOI: 10.1093/eurheartjsupp/suac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Fragmentation of healthcare systems through limited cross-speciality communication and intermittent, intervention-based care, without insight into follow-up and compliance, results in poor patient experiences and potentially contributes to suboptimal outcomes. Data-driven tools and novel technologies have the capability to address these shortcomings, but insights from all stakeholders in the care continuum remain lacking. A structured online questionnaire was given to respondents (n = 1432) in nine global geographies to investigate attitudes to the use of data and novel technologies in the management of vascular disease. Patients with coronary or peripheral artery disease (n = 961), physicians responsible for their care (n = 345), and administrators/healthcare leaders with responsibility for commissioning/procuring cardiovascular services (n = 126) were included. Narrative themes arising from the survey included patients' desire for more personalized healthcare, shared decision-making, and improved communication. Patients, administrators, and physicians perceived and experienced deficiencies in continuity of care, and all acknowledged the potential for data-driven techniques and novel technologies to address some of these shortcomings. Further, physicians and administrators saw the 'upstream' segment of the care journey-before diagnosis, at point of diagnosis, and when determining treatment-as key to enabling tangible improvements in patient experience and outcomes. Finally, despite acceptance that data sharing is critical to the success of such interventions, there remains persistent issues related to trust and transparency. The current fragmented care continuum could be improved and streamlined through the adoption of advanced data analytics and novel technologies, including diagnostic and monitoring techniques. Such an approach could enable the refocusing of healthcare from intermittent contacts and intervention-only focus to a more holistic patient view.
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Affiliation(s)
- Nick E J West
- Abbott Vascular, 3200 Lakeside Drive, Santa Clara, CA 95054, USA
| | - Maneesh Juneja
- MJ Analytics Ltd, Hemel Hempstead, Hertfordshire HP1 1FW, UK
| | - Natalia Pinilla
- Division of Cardiology/Population Health Research Institute, McMaster University, Hamilton, ON L8L 2X2, Canada
| | - Koen R De Loose
- AZ Sint Blasius, Sint-Blasius, Kroonveldlaan 50, 9200 Dendermonde, Belgium
| | - Timothy D Henry
- The Carl and Edyth Lindner Research Center at The Christ Hospital, 2123 Auburn Avenue, Suite 424, Cincinnati, OH 45219, USA
| | | | - Olga Kraineva
- Abbott Vascular, 3200 Lakeside Drive, Santa Clara, CA 95054, USA
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Isakadze N, Molello N, MacFarlane Z, Gao Y, Spaulding EM, Commodore Mensah Y, Marvel FA, Khoury S, Marine JE, Michos ED, Spragg D, Berger RD, Calkins H, Cooper LA, Martin SS. The Virtual Inclusive Digital Health Intervention Design to Promote Health Equity (iDesign) Framework for Atrial Fibrillation: Co-design and Development Study. JMIR Hum Factors 2022; 9:e38048. [DOI: 10.2196/38048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/28/2022] [Accepted: 08/02/2022] [Indexed: 11/05/2022] Open
Abstract
Background
Smartphone ownership and mobile app use are steadily increasing in individuals of diverse racial and ethnic backgrounds living in the United States. Growing adoption of technology creates a perfect opportunity for digital health interventions to increase access to health care. To successfully implement digital health interventions and engage users, intervention development should be guided by user input, which is best achieved by the process of co-design. Digital health interventions co-designed with the active engagement of users have the potential to increase the uptake of guideline recommendations, which can reduce morbidity and mortality and advance health equity.
Objective
We aimed to co-design a digital health intervention for patients with atrial fibrillation, the most common cardiac arrhythmia, with patient, caregiver, and clinician feedback and to describe our approach to human-centered design for building digital health interventions.
Methods
We conducted virtual meetings with patients with atrial fibrillation (n=8), their caregivers, and clinicians (n=8). We used the following 7 steps in our co-design process: step 1, a virtual meeting focused on defining challenges and empathizing with problems that are faced in daily life by individuals with atrial fibrillation and clinicians; step 2, a virtual meeting focused on ideation and brainstorming the top challenges identified during the first meeting; step 3, individualized onboarding of patients with an existing minimally viable version of the atrial fibrillation app; step 4, virtual prototyping of the top 3 ideas generated during ideation; step 5, further ranking by the study investigators and engineers of the ideas that were generated during ideation but were not chosen as top-3 solutions to be prototyped in step 4; step 6, ongoing engineering work to incorporate top-priority features in the app; and step 7, obtaining further feedback from patients and testing the atrial fibrillation digital health intervention in a pilot clinical study.
Results
The top challenges identified by patients and caregivers included addressing risk factor modification, medication adherence, and guidance during atrial fibrillation episodes. Challenges identified by clinicians were complementary and included patient education, addressing modifiable atrial fibrillation risk factors, and remote atrial fibrillation episode management. Patients brainstormed more than 30 ideas to address the top challenges, and the clinicians generated more than 20 ideas. Ranking of the ideas informed several novel or modified features aligned with the Theory of Health Behavior Change, features that were geared toward risk factor modification; patient education; rhythm, symptom, and trigger correlation for remote atrial fibrillation management; and social support.
Conclusions
We co-designed an atrial fibrillation digital health intervention in partnership with patients, caregivers, and clinicians by virtually engaging in collaborative creation through the design process. We summarize our experience and describe a flexible approach to human-centered design for digital health intervention development that can guide innovative clinical investigators.
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Johnson T, Isakazde N, Mathews L, Gao Y, MacFarlane Z, Spaulding EM, Martin SS, Marvel FA. Building a hybrid virtual cardiac rehabilitation program to promote health equity: Lessons learned. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:158-160. [PMID: 36046432 PMCID: PMC9422060 DOI: 10.1016/j.cvdhj.2022.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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23
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Taki F, Lurie J, Kaur G. An ethical plan for including forcibly displaced persons in omics and digital technology research. Nat Med 2022; 28:1116-1120. [PMID: 35513531 PMCID: PMC9464352 DOI: 10.1038/s41591-022-01801-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Forcibly displaced persons, such as refugees, are at an increased risk of physical and mental health conditions and so would benefit from novel healthcare technologies, research on which can be conducted under an ethical framework.
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Affiliation(s)
- Faten Taki
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
| | - Jacob Lurie
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Gunisha Kaur
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
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24
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Digital health RCT interventions for cardiovascular disease risk reduction: a systematic review and meta-analysis. HEALTH AND TECHNOLOGY 2022; 12:687-700. [PMID: 35350665 PMCID: PMC8947848 DOI: 10.1007/s12553-022-00651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/19/2022] [Indexed: 11/16/2022]
Abstract
Heart disease is a leading cause of UK mortality. Evidence suggests digital health interventions (DHIs), such as smartphone applications, may reduce cardiovascular risk, but no recent reviews are available. This review examined the effect of DHIs on cardiovascular disease (CVD) risk scores in patients with increased CVD risk, compared to usual care alone. PubMed, Cochrane Database, Medline, and Google Scholar were searched for eligible trials published after 01/01/2010, involving populations with at least one CVD risk factor. Primary outcome was change in CVD risk score (e.g. QRISK3) between baseline and follow-up. Meta-analysis was undertaken using Revman5/STATA using random-effects modelling. Cochrane RoB-2 tool determined risk-of-bias. 6 randomised controlled trials from 36 retrieved articles (16.7%) met inclusion criteria, involving 1,157 patients treated with DHIs alongside usual care, and 1,127 patients offered usual care only (control group). Meta-analysis using random-effects model in STATA showed an inconclusive effect for DHIs as effective compared to usual care (Mean Difference, MD -0.76, 95% CI -1.72, 0.20), with moderate certainty (GRADEpro). Sensitivity analysis by DHI modality suggested automated email messaging was the most effective DHI (MD -1.09, 95% Cl -2.15, -0.03), with moderate certainty (GRADEpro). However, substantial study heterogeneity was noted in main and sensitivity analyses (I2 = 66% and 64% respectively). Quality assessment identified risk-of-bias concerns, particularly for outcome measurement. Findings suggest specific DHIs such as automated email messaging may improve CVD risk outcomes, but were inconclusive for DHIs overall. Further research into specific DHI modalities is required, with longer follow-up.
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Wong BLH, Maaß L, Vodden A, van Kessel R, Sorbello S, Buttigieg S, Odone A. The dawn of digital public health in Europe: Implications for public health policy and practice. Lancet Reg Health Eur 2022; 14:100316. [PMID: 35132399 PMCID: PMC8811486 DOI: 10.1016/j.lanepe.2022.100316] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The COVID-19 pandemic has highlighted the importance of digital health technologies and the role of effective surveillance systems. While recent events have accelerated progress towards the expansion of digital public health (DPH), there remains significant untapped potential in harnessing, leveraging, and repurposing digital technologies for public health. There is a particularly growing need for comprehensive action to prepare citizens for DPH, to regulate and effectively evaluate DPH, and adopt DPH strategies as part of health policy and services to optimise health systems improvement. As representatives of the European Public Health Association's (EUPHA) Digital Health Section, we reflect on the current state of DPH, share our understanding at the European level, and determine how the application of DPH has developed during the COVID-19 pandemic. We also discuss the opportunities, challenges, and implications of the increasing digitalisation of public health in Europe.
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26
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Eckardt I, Düsing P, Nickenig G, Jansen F. Smart devices resulting in big effect: can apps cure heart disease? Eur Heart J 2022; 43:2003-2004. [PMID: 35134887 DOI: 10.1093/eurheartj/ehab917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Irina Eckardt
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Philip Düsing
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix Jansen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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27
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Brownstein AJ, Derenbecker R, Gao Y, Ding J, Varghese B, Isakadze N, Spaulding EM, Marvel FA, Martin SS. Application of the very high risk criterion and evaluation of cholesterol guideline adherence in acute myocardial infarction patients at an urban academic medical center. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100082. [PMID: 38560081 PMCID: PMC10978217 DOI: 10.1016/j.ahjo.2021.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 04/04/2024]
Abstract
Objective The 2018 AHA/ACC cholesterol guidelines recommend considering non-statin agents among very high-risk (VHR) patients with LDL-C ≥ 70 mg/dL after maximizing statin therapy. We aimed to evaluate the prevalence of VHR status in acute myocardial infarction (AMI) patients at hospital discharge and the adherence to guideline-directed cholesterol therapy (GDCT) within one-year follow-up post-AMI. Methods We performed a retrospective analysis of patients who suffered a type 1 AMI between October 2015 and March 2019, and then were followed at our institution for 1 year after hospital discharge. We calculated the percentage of patients at VHR and among those with follow up lipid panels, we determined the proportion able to achieve GDCT. Results The mean age of the 331 AMI patients was 61.0 (SD 11.9) years and 33.6% were women. Overall, 268 (81.0%) patients were categorized as having VHR at discharge. Among patients at VHR, a lipid panel was rechecked in 153 individuals (57.1%) within 1 year of discharge, with the median time to lipid recheck being 22.4 weeks (interquartile range: 10.9-40.7 weeks). Among those with a lipid panel re-check, 100 (65.4%) of patients achieved GDCT. Conclusions Approximately 4 out of 5 AMI patients were considered VHR per the 2018 AHA/ACC guidelines, only about half had follow up lipid panels in the year following AMI, and about two-thirds of those with follow up lipid panels achieved GDCT.
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Affiliation(s)
- Adam J. Brownstein
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Derenbecker
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yumin Gao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jie Ding
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bibin Varghese
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nino Isakadze
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin M. Spaulding
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Francoise A. Marvel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, USA
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Choi JY, Kim JB, Lee S, Lee SJ, Shin SE, Park SH, Park EJ, Kim W, Na JO, Choi CU, Rha SW, Park CG, Seo HS, Ahn J, Jeong HG, Kim EJ. A Smartphone App (AnSim) With Various Types and Forms of Messages Using the Transtheoretical Model for Cardiac Rehabilitation in Patients With Coronary Artery Disease: Development and Usability Study. JMIR Med Inform 2021; 9:e23285. [PMID: 34878987 PMCID: PMC8693185 DOI: 10.2196/23285] [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: 08/08/2020] [Revised: 03/27/2021] [Accepted: 10/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Despite strong evidence of clinical benefit, cardiac rehabilitation (CR) programs are currently underutilized and smartphone-based CR strategies are thought to address this unmet need. However, data regarding the detailed process of development are scarce. Objective This study focused on the development of a smartphone-based, patient-specific, messaging app for patients who have undergone percutaneous coronary intervention (PCI). Methods The AnSim app was developed in collaboration with a multidisciplinary team that included cardiologists, psychiatrists, nurses, pharmacists, nutritionists, and rehabilitation doctors and therapists. First, a focus group interview was conducted, and the narratives of the patients were analyzed to identify their needs and preferences. Based on the results, health care experts and clinicians drafted messages into 5 categories: (1) general information regarding cardiovascular health and medications, (2) nutrition, (3) physical activity, (4) destressing, and (5) smoking cessation. In each category, 90 messages were developed according to 3 simplified steps of the transtheoretical model of behavioral change: (1) precontemplation, (2) contemplation and preparation, and (3) action and maintenance. After an internal review and feedback from potential users, a bank of 450 messages was developed. Results The focus interview was conducted with 8 patients with PCI within 1 year, and 450 messages, including various forms of multimedia, were developed based on the transtheoretical model of behavioral change in each category. Positive feedback was obtained from the potential users (n=458). The mean Likert scale score was 3.95 (SD 0.39) and 3.91 (SD 0.39) for readability and usefulness, respectively, and several messages were refined based on the feedback. Finally, the patient-specific message delivery system was developed according to the baseline characteristics and stages of behavioral change in each participant. Conclusions We developed an app (AnSim), which includes a bank of 450 patient-specific messages, that provides various medical information and CR programs regarding coronary heart disease. The detailed process of multidisciplinary collaboration over the course of the study provides a scientific basis for various medical professionals planning smartphone-based clinical research.
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Affiliation(s)
- Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Bak Kim
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sunki Lee
- Division of Cardiology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Republic of Korea
| | - Seo-Joon Lee
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Eon Shin
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | | | - Eun Jin Park
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eung Ju Kim
- Sports Medical Center, Seoul, Republic of Korea
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Bhardwaj V, Spaulding EM, Marvel FA, LaFave S, Yu J, Mota D, Lorigiano TJ, Huynh PP, Shan R, Yesantharao PS, Lee MA, Yang WE, Demo R, Ding J, Wang J, Xun H, Shah L, Weng D, Wongvibulsin S, Carter J, Sheidy J, McLin R, Flowers J, Majmudar M, Elgin E, Vilarino V, Lumelsky D, Leung C, Allen JK, Martin SS, Padula WV. Cost-effectiveness of a Digital Health Intervention for Acute Myocardial Infarction Recovery. Med Care 2021; 59:1023-1030. [PMID: 34534188 PMCID: PMC8516712 DOI: 10.1097/mlr.0000000000001636] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is a common cause of hospital admissions, readmissions, and mortality worldwide. Digital health interventions (DHIs) that promote self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction may improve health outcomes in this population. The "Corrie" DHI consists of a smartphone application, smartwatch, and wireless blood pressure monitor to support medication tracking, education, vital signs monitoring, and care coordination. We aimed to assess the cost-effectiveness of this DHI plus standard of care in reducing 30-day readmissions among AMI patients in comparison to standard of care alone. METHODS A Markov model was used to explore cost-effectiveness from the hospital perspective. The time horizon of the analysis was 1 year, with 30-day cycles, using inflation-adjusted cost data with no discount rate. Currencies were quantified in US dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). The results were interpreted as an incremental cost-effectiveness ratio at a threshold of $100,000 per QALY. Univariate sensitivity and multivariate probabilistic sensitivity analyses tested model uncertainty. RESULTS The DHI reduced costs and increased QALYs on average, dominating standard of care in 99.7% of simulations in the probabilistic analysis. Based on the assumption that the DHI costs $2750 per patient, use of the DHI leads to a cost-savings of $7274 per patient compared with standard of care alone. CONCLUSIONS Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs.
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Affiliation(s)
- Vinayak Bhardwaj
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Erin M. Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD, US
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Francoise A. Marvel
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Sarah LaFave
- Johns Hopkins University School of Nursing, Baltimore, MD, US
| | - Jeffrey Yu
- Johns Hopkins Health System, Baltimore, MD, US
- Dept. of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, US
| | - Daniel Mota
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Dimock Center, Baltimore, MD, US
| | | | - Pauline P. Huynh
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Rongzi Shan
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Pooja S. Yesantharao
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Matthias A. Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, US
| | - William E. Yang
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, US
| | - Jie Ding
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Jane Wang
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Helen Xun
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Lochan Shah
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Daniel Weng
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Shannon Wongvibulsin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | | | | | | | | | - Maulik Majmudar
- Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | | | - Valerie Vilarino
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD, US
| | - David Lumelsky
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD, US
| | | | - Jerilyn K. Allen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Johns Hopkins University School of Nursing, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Seth S. Martin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, US
| | - William V. Padula
- Dept. of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, US
- Leonard D. Schaeffer Center for Health Economics & Policy, University of Southern California, Los Angeles, CA
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