Cardiology in a Digital Age: Opportunities and Challenges for e-Health: A Literature Review

The present and future of cardiological telemonitoring in Europe: a statement from seven European countries

Cardiovascular diseases remain one of the leading causes of death worldwide, placing a significant burden on individuals, families and healthcare systems. Telemedicine, in particular remote monitoring of patients with cardiovascular diseases, reduces this burden as it links the continuous monitoring of the health status with individual education and adaptation of the therapy to the needs of the patients. This improves patient outcomes and facilitates access to specialised healthcare services, independent of time and distance. Furthermore, telemedicine enables improvements in efficiency and promotes patients' self-care. However, the widespread adoption of remote patient monitoring faces several hurdles. A round table of experts from seven European countries (France, Germany, Italy, Poland, Spain, the Netherlands and the United Kingdom) reviewed the current state of telemedicine within the participating countries in order to learn from each other with an impetus for European co-operation. The creation of reliable regulations, overcoming regional differences, the redefinition of roles and processes, the personalisation of healthcare services, the promotion of innovation and research, the use of artificial intelligence and, finally, the efficient management and safeguarding of healthcare data were identified as key levers for further development of telemedicine. This discussion paper emphasises the need for cross-national research activities, involving all stakeholders, such as researchers, industry and patients, to foster the integration of telemedicine in clinical pathways.

Mobile/wearable digital devices for care of active cancer patients: a survey from the ESC Council of Cardio-Oncology

Aims

The Council of Cardio-Oncology of the European Society of Cardiology developed an on-line anonymous survey to provide an overall picture of the current practice on the use of mobile and wearable digital devices in cardio-oncology and the potential barriers to their large-scale applicability.

Methods and results

Between June 2023 and January 2024, an online anonymous questionnaire was completed by 220 healthcare professionals from 55 countries. The greatest number of respondents reported that mobile/wearable digital devices have a role in all active cancer patients for measuring heart rate (33.9%), blood pressure (34.4%), body temperature (32.0%), physical activity (42.4%), and sleep (31.2%). In the setting of atrial fibrillation detection, respondents were evenly split between applying these technologies in all patients (33.0%) or only in selected patients (33.0%). Regarding QTc interval monitoring, 30.6% reported that mobile/wearable digital devices play a role only in selected patients. The decision to use the device was taken by the patient in 56.6% of cases and the physician in 43.4%. The most important barrier reported to mobile/wearable device implementation in the setting of cardiac rhythm monitoring and QTc measurement was their cost (weighted average: 3.38 and 3.39, respectively).

Conclusion

Mobile/wearable digital devices are considered to play an important role in different settings of cardio-oncology, including monitoring of patients' parameters and arrhythmia detection. Their role in monitoring physical activity and QTc interval appears more nuanced. The most important perceived barrier to mobile/wearable digital device implementation is considered their high cost.

A double-edged sword?: Digitalization, health disparities, and the paradoxical case of e-pharmacy in Ghana

Objective

With the ongoing push for greater digitalization of healthcare in low- and middle- income countries (LMICs), the larger questions around who will benefit most from such efforts and what elements of disparities and inequities may further be created or reinforced are often overlooked. This study was undertaken to assess a pioneering e-pharmacy initiative in Ghana that aimed to explore issues of access and disparities in relation to pharmaceutical services.

Method

The study used a qualitative research design where semi-structured interviews were conducted virtually with 21 licensed community pharmacists recruited through purposive and snowball sampling techniques. The data were analyzed using inductive thematic analysis approach.

Results

Pharmacists recognized the transformative potential of e-pharmacies, particularly in resource constrained regions that face issues of pharmacy and healthcare deserts. However, drawing on their experiential knowledge, they highlighted the paradoxes and challenges of promoting digitalization of healthcare in a country characterized by poor infrastructure, poverty, and multiple intersecting layers of inequities, as well as digital divides and low digital/health literacy. In the absence of adequate infrastructure, funding support and regulation, the possibility of local pharmacies, often the first point of care, being replaced by big corporations was feared. Participants also cautioned to steer the discourse of e-pharmacy away from access, pricing, and convenience to safety and quality.

Conclusion

Digitalization of healthcare and e-pharmacies holds tremendous potential in the LMICs. However, such technological initiatives, if implemented without proper groundwork and adequate support, would run the risk of creating and exacerbating health disparities, especially in sub-Saharan Africa. A bottom-up approach, through grassroot engagement and implementation science, tethered to building safe, affordable, and equitable infrastructure and access to care will be essential for the success of e-pharmacy and other digitalization initiatives in the region and beyond. This research has direct implications for public health, policy, and pharmaceutical care.

Enhancing cardiac postoperative care: a smartwatch-integrated remote telemonitoring platform for health screening with ECG analysis

Aims

The integration of smartwatches into postoperative cardiac care transforms patient monitoring, systematically tracking vital signs and delivering real-time data to a centralized platform. This study focuses on developing a platform for seamless integration, assessing reliability, and evaluating the impact on post-cardiac surgery. The goal is to establish a robust foundation for understanding the efficacy and dependability of smartwatch-based telemonitoring, enhancing care for this population.

Methods and results

A total of 108 cardiac surgery patients were divided into telemonitoring (TLM) and control (CTL) groups. The TLM group utilized smartwatches for continuous monitoring of vital parameters (SpO2, HR, BP, ECG) over 30 ± 3 days. Statistical analyses (Pearson, Intraclass Correlation, Bland-Altman, Tost Test) were employed to compare smartwatch measurements with traditional methods. Significant correlations and concordance were observed, particularly in HR and BP measurements. Challenges were noted in SpO2 measurement. The ECG algorithm exhibited substantial agreement with cardiologists (Kappa: 0.794; p > 0.001), highlighting its reliability. The telemonitoring platform played a crucial role in early detection of clinical changes, including prompt Emergency Department (ED) visits, contributing significantly to preventing outcomes that could lead to mortality, such as asymptomatic Atrioventricular block. Positive patient responses affirmed technological efficacy, especially in identifying cardiac arrhythmias like atrial fibrillation.

Conclusion

The integration of smartwatches into remote telemonitoring for postoperative cardiac care demonstrates substantial potential, improving monitoring and early complication detection, thereby enhancing patient outcomes. The FAPO-X Study (Assisted Digital Telemonitoring with Wearables in Patients After Cardiovascular Surgery; NCT05966857) underscores the promising role of telemonitoring in postoperative cardiac care.

Digital health technologies in enhancing patient and caregiver engagement in heart failure management: Opportunities and challenges

The management of heart failure has undergone significant evolution, advancing from the initial utilization of digitalis and diuretics to the contemporary practice of personalized medicine and sophisticated device therapy. Despite these advancements, the persistent challenge of high hospitalization and readmission rates underscores an urgent need for innovative solutions. This manuscript explores how the integration of digital health technologies into interventional cardiology marks a paradigm shift in the management of heart failure. These technologies are no longer mere adjuncts but have become foundational to a modern approach, providing tools for continuous monitoring, patient education, and improved outcomes post-intervention. Through an examination of current trends, this perspective article highlights the transformative impact of wearable technologies, telehealth platforms, and advanced analytical tools in reshaping patient engagement and enabling proactive care strategies. Case studies illustrate the practical advantages, including enhanced medication adherence, early detection of heart failure signs, and a reduction in healthcare facility burdens. Central to this new digital health landscape is the Information Technology Management (ITM) system, a framework poised to revolutionize patient and caregiver engagement and pave the way for the future of interventional cardiology. This manuscript delineates the ITM system's innovative architecture and its consequential role in refining current and prospective cardiological interventions.

Diagnostic criteria and scoring systems for thyroid storm: An evaluation of their utility - comparative review

A thyroid storm is a life-threatening endocrine emergency characterized by severe hyperthyroidism and many systemic manifestations. Prompt recognition and treatment are essential for patient survival. This study evaluates the utility of existing diagnostic criteria and scoring systems for thyroid storm. A comprehensive literature review encompassed articles published up to December 2023. Various diagnostic criteria and scoring systems, such as the Burch-Wartofsky Point Scale and the Japanese Thyroid Association criteria, were critically assessed based on their sensitivity, specificity, and clinical applicability. Our findings reveal that existing diagnostic criteria and scoring systems, although valuable tools, exhibit limitations. They may lack sensitivity in identifying milder cases of thyroid storm or fail to differentiate it from other critical conditions. Furthermore, some criteria rely heavily on subjective clinical Judgment, which can vary among healthcare providers. Future research should focus on refining existing criteria and developing more objective and universally applicable diagnostic tools to address these limitations. Incorporating advanced laboratory markers and modern imaging techniques may enhance diagnostic accuracy. Additionally, a standardized scoring system approach could improve clinical practice consistency. In conclusion, while current diagnostic criteria and scoring systems provide a foundation for identifying thyroid storm, their utility has shortcomings. Advancements in diagnostic methods and a collaborative effort to establish standardized criteria are imperative to enhance the accuracy and reliability of thyroid storm diagnosis, ultimately improving patient outcomes.

A pediatric telecardiology system that facilitates integration between hospital-based services and community-based primary care

INTRODUCTION

Telecardiology has emerged as a vital field within telemedicine, fostering collaboration between hospital and community medicine. This pilot study introduces an innovative pediatric telecardiology system, comprising a telecardiology system seamlessly integrated with a hospital telemedicine platform. A smooth flow of ECG execution, transmission, and reporting between Primary Care Pediatrician clinics and the hospital was tested as the primary objective. User experience surveys were also considered.

METHODS

The study involved three Primary Care Pediatrician clinics, and the enrollment of children took place consecutively from January to July 2023. We integrated a digital electrocardiographic signal acquisition unit and online information transmission-capable tablets, that were provided to the pediatricians, with a telemedicine multitenant platform that facilitated the transmission of the patient's ECG data from the community to the Hospital Pediatric Cardiologist.

RESULTS

A total of 158 children (80 M/78F, 8.9 ± 2.8 yrs) underwent ECG recording (78.5 % medical certificates, 21.5 % presence of symptoms) The transmission and reporting of ECGs were successfully completed in all cases, without technical issues. Normal findings on the ECG were demonstrated in 94.9 % of children. 70.8 % of respondents completed all parts of the survey. Respondents had a high level of education (90 %) and demonstrated excellent or good competence in using digital technologies (89 %). 51 % of respondents were not familiar with the term "Telemedicine" and 81 % of the cases had no previous telemedicine experience. 90 % of users were very satisfied or satisfied with the service. Connection problems (2.8 %) and concerns about the service's reliability compared to standard care (3.7 %) were mentioned as possible limitations of the telecardiology.

CONCLUSIONS

Our pediatric telecardiology system offers a valuable diagnostic tool to enhance patient management in the community.

Cardiology in the digital era: from artificial intelligence to Metaverse, paving the way for future advancements

Tweetable abstract Cardiology's digital revolution: AI diagnoses, ChatGPT consults, Metaverse educates. Challenges & promises explored. #CardiologyTech #DigitalHealth.