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Schwalm J, Joseph P, Leong D, Lopez-Lopez JP, Onuma O, Bhatt P, Avezum A, Walli-Attaei M, McKee M, Salim Y. Cardiovascular disease in the Americas: optimizing primary and secondary prevention of cardiovascular disease series: cardiovascular disease in the Americas. LANCET REGIONAL HEALTH. AMERICAS 2025; 42:100964. [PMID: 40034111 PMCID: PMC11873640 DOI: 10.1016/j.lana.2024.100964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 11/18/2024] [Accepted: 12/02/2024] [Indexed: 03/05/2025]
Abstract
While, many interventions can prevent cardiovascular disease (CVD), and its resulting morbidity or mortality, these are used sub-optimally in most countries. Therefore, health systems need to develop new approaches to ensure that proven CVD therapies are delivered widely. In this review, we describe five impactful implementation strategies which include: (1) Task shifting, (2) Use of mobile-Health (mHealth) support and virtual access to care, (3) simplified diagnostic and management algorithms for the prevention of CVD, (4) improving the use of combinations of medicines (i.e., polypill), and (5) patient engagement and role of patient-nominated peer support (i.e., treatment supporters). Adapting and tailoring these strategies to the local context in different settings in various countries in the Americas and the Caribbean can reduce the morbidity and mortality of CVD substantially.
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Affiliation(s)
- J.D. Schwalm
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
- Centre for Evidence-Based Implementation, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Darryl Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jose Patricio Lopez-Lopez
- Masira Research Institute, Universidad de Santander (UDES), Bucaramanga, Colombia
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Oyere Onuma
- Massachusetts General Hospital, Boston, MA, USA
| | - Palki Bhatt
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Marjan Walli-Attaei
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Yusuf Salim
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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Lyu M, Zhao Q, Yang Y, Hao X, Qin Y, Li K. Benefits of and barriers to telehealth for the informal caregivers of elderly individuals in rural areas: A scoping review. Aust J Rural Health 2022; 30:442-457. [PMID: 35460580 DOI: 10.1111/ajr.12869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/25/2022] [Accepted: 03/07/2022] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Maintaining care for elderly individuals in rural areas is heavily dependent on support from informal caregivers. Many informal caregivers of the elderly in rural areas feel burdened and urgently require professional support. Interests in telehealth that can provide support irrespective of geographical location have been increasing. OBJECTIVE To identify the benefits of and barriers in telehealth engagement for rural caregivers to provide evidence for service improvement. DESIGN A scoping review method was used following PRISMA-ScR guidelines and Arksey and O'Malley's five-stage framework. Five databases were searched. The search terms were chosen based on the target intervention (i.e. telehealth), target population (caregivers of elderly individuals) and target context (rural areas). Two authors independently assessed the eligibility of studies and extracted data from eligible studies. FINDINGS Of 4220 retrieved studies, 19 articles met the inclusion criteria. This study identified four benefits of and two barriers to telehealth for rural caregivers. Four subthemes were identified as the key benefits in using telehealth for caregivers: decrease in psychological distress, increase in care efficiency, increase in social support and increase in access to resources, while inadequate telehealth infrastructures and caregivers' own reasons were the primary barriers in using telehealth for those populations. CONCLUSIONS Telehealth was shown to significantly benefit rural caregivers. Future research can be designed and conducted for overcoming the barriers to telehealth. Additionally, the benefits identified by this review need to be translated from research into practice for rural caregivers' care.
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Affiliation(s)
- Miaohua Lyu
- School of Nursing, Jilin University, Changchun, China
| | - Qiheng Zhao
- Orthopaedics Department, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China
| | - Xiaonan Hao
- School of Nursing, Jilin University, Changchun, China
| | - Yuan Qin
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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Abstract
This work presents XBeats, a novel platform for real-time electrocardiogram monitoring and analysis that uses edge computing and machine learning for early anomaly detection. The platform encompasses a data acquisition ECG patch with 12 leads to collect heart signals, perform on-chip processing, and transmit the data to healthcare providers in real-time for further analysis. The ECG patch provides a dynamically configurable selection of the active ECG leads that could be transmitted to the backend monitoring system. The selection ranges from a single ECG lead to a complete 12-lead ECG testing configuration. XBeats implements a lightweight binary classifier for early anomaly detection to reduce the time to action should abnormal heart conditions occur. This initial detection phase is performed on the edge (i.e., the device paired with the patch) and alerts can be configured to notify designated healthcare providers. Further deep analysis can be performed on the full fidelity 12-lead data sent to the backend. A fully functional prototype of the XBeats has been implemented to demonstrate the feasibly and usability of the proposed system. Performance evaluation shows that XBeats can achieve up to 95.30% detection accuracy for abnormal conditions, while maintaining a high data acquisition rate of up to 441 samples per second. Moreover, the analytical results of the energy consumption profile show that the ECG patch provides up to 37 h of continuous 12-lead ECG streaming.
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Yamano T, Kotani K, Kitano N, Morimoto J, Emori H, Takahata M, Fujita S, Wada T, Ota S, Satogami K, Kashiwagi M, Shiono Y, Kuroi A, Tanimoto T, Tanaka A. Telecardiology in Rural Practice: Global Trends. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074335. [PMID: 35410012 PMCID: PMC8998494 DOI: 10.3390/ijerph19074335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022]
Abstract
The management of cardiovascular diseases in rural areas is plagued by the limited access of rural residents to medical facilities and specialists. The development of telecardiology using information and communication technology may overcome such limitation. To shed light on the global trend of telecardiology, we summarized the available literature on rural telecardiology. Using PubMed databases, we conducted a literature review of articles published from January 2010 to December 2020. The contents and focus of each paper were then classified. Our search yielded nineteen original papers from various countries: nine in Asia, seven in Europe, two in North America, and one in Africa. The papers were divided into classified fields as follows: seven in tele-consultation, four in the telemedical system, four in the monitoring system, two in prehospital triage, and two in tele-training. Six of the seven tele-consultation papers reported the consultation from rural doctors to urban specialists. More reports of tele-consultations might be a characteristic of telecardiology specific to rural practice. Further work is necessary to clarify the improvement of cardiovascular outcomes for rural residents.
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Affiliation(s)
- Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
- Correspondence:
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke 329-0498, Japan;
| | - Naomi Kitano
- Health Administration Center, Wakayama Medical University, Wakayama 641-0012, Japan;
| | - Junko Morimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Suwako Fujita
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Keisuke Satogami
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama 641-0012, Japan; (J.M.); (H.E.); (M.T.); (S.F.); (T.W.); (S.O.); (K.S.); (M.K.); (Y.S.); (A.K.); (T.T.); (A.T.)
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Telemedicine maybe an effective solution for management of chronic disease during the COVID-19 epidemic. Prim Health Care Res Dev 2021; 22:e48. [PMID: 34583801 PMCID: PMC8488977 DOI: 10.1017/s1463423621000517] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: Based on the development of telemedicine and the experience of using it during the COVID-19 epidemic, we aimed to explore its convenience and shortcomings to provide a reference for the further improvement of telemedicine. Background: Traditional healthcare has been significantly affected by the outbreak of COVID-19, which has increased fear in patients with chronic diseases and increased the difficulty of obtaining hospitalized treatment. Methods: This is a conceptual article. The literature search is based on Pubmed, including articles published between January 2015 and December 2020. The purpose was to determine whether telemedicine is effective in the management of chronic diseases in the epidemic situation and to develop telemedicine and chronic disease management for long-term epidemic situations in the future. Findings: Telemedicine has demonstrated its advantages during the COVID-19 epidemic and can provide diversified clinical care services for patients with chronic diseases; these services have played a vital role in epidemic prevention and control, greatly alleviated the shortage of medical resources, increased the utilization level of medical resources, and reduced the cross-infection risk during treatment in hospitals. Furthermore, the epidemic situation presents opportunities for the development of diagnosis and treatment methods via the internet and active health management modalities.
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Embedded real-time feature extraction for electrode inversion detection in telemedicine electrocardiograms. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Arm-ECG Wireless Sensor System for Wearable Long-Term Surveillance of Heart Arrhythmias. ELECTRONICS 2019. [DOI: 10.3390/electronics8111300] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article presents the devising, development, prototyping and assessment of a wearable arm-ECG sensor system (WAMECG1) for long-term non-invasive heart rhythm monitoring, and functionalities for acquiring, storing, visualizing and transmitting high-quality far-field electrocardiographic signals. The system integrates the main building blocks present in a typical ECG monitoring device such as the skin surface electrodes, front-end amplifiers, analog and digital signal conditioning filters, flash memory and wireless communication capability. These are integrated into a comfortable, easy to wear, and ergonomically designed arm-band ECG sensor system which can acquire a bipolar ECG signal from the upper arm of the user over a period of 72 h. The small-amplitude bipolar arm-ECG signal is sensed by a reusable, long-lasting, Ag–AgCl based dry electrode pair, then digitized using a programmable sampling rate in the range of 125 to 500 Hz and transmitted via Wi-Fi. The prototype comparative performance assessment results showed a cross-correlation value of 99.7% and an error of less than 0.75% when compared to a reference high-resolution medical-grade ECG system. Also, the quality of the recorded far-field bipolar arm-ECG signal was validated in a pilot trial with volunteer subjects from within the research team, by wearing the prototype device while: (a) resting in a chair; and (b) doing minor physical activities. The R-peak detection average sensibilities were 99.66% and 94.64%, while the positive predictive values achieved 99.1% and 92.68%, respectively. Without using any additional algorithm for signal enhancement, the average signal-to-noise ratio (SNR) values were 21.71 and 18.25 for physical activity conditions (a) and (b) respectively. Therefore, the performance assessment results suggest that the wearable arm-band prototype device is a suitable, self-contained, unobtrusive platform for comfortable cardiac electrical activity and heart rhythm logging and monitoring.
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