JMIR Cardio最新文献

Background: Coronary heart disease (CHD) continues to account for a substantial proportion of deaths worldwide. Ballistocardiogram (BCG), a noncontact, noninvasive technique for monitoring cardiac activity, has gained increasing attention for its potential role in various medical applications, particularly in CHD. This review comprehensively explores the applications of BCG in the diagnostic evaluation of CHD.

Objective: The aim of this systematic review is to evaluate the clinical applications and diagnostic capabilities of BCG in CHD, with the ultimate goal of enhancing the precision of CHD management and optimizing therapeutic decision-making pathways.

Methods: A literature search was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines to identify studies evaluating the use of BCG in CHD. The initial search identified 500 studies. Based on titles, abstracts, and keywords, 266 studies were selected for further review. Following further exclusion of non-English articles, animal studies, and review articles, 38 eligible studies were included in the final analysis.

Results: Among the 38 studies, 22 focused on the application of BCG in acute coronary syndrome. These studies explored various aspects, including BCG waveforms in patients with acute myocardial infarction, the diagnosis of acute coronary syndrome, and the relationship between age and the rate of abnormal BCG waveforms. The remaining studies covered the effects of drugs, emotions, exercise, and other variables on BCG recordings in patients with CHD. Sample sizes varied significantly across the studies, 36 studies explicitly reported sample sizes, encompassing a total of 9479 participants with individual study sizes ranging from 1 to 903 cases. Notably, 13 studies enrolled fewer than 50 participants, raising concerns about potential selection bias and reduced reliability of the findings.

Conclusions: Overall, while BCG demonstrates significant potential in the diagnosis and prevention of CHD, several limitations remain. Variability in study design, sample size, and outcome measures poses challenges to the generalizability of findings. Nevertheless, the capability of BCG to reflect cardiac function and assist in the detection of CHD remains valuable. With continued research and technological advancement, BCG has the potential to transform current approaches to CHD diagnosis and management, ultimately improving patient outcomes and quality of life.

Background: Apolipoprotein B (APOB) rs676210 polymorphism has been associated with altered lipid metabolism and cardiovascular risk in various populations; however, data from Vietnamese populations remain limited.

Objective: This study aimed to investigate the association of the APOB rs676210 variant with lipid profiles among Vietnamese individuals newly diagnosed with elevated low-density lipoprotein cholesterol (LDL-C).

Methods: A cross-sectional study was conducted among 69 Vietnamese adults newly diagnosed with elevated LDL-C (≥130 mg/dL) at a tertiary hospital in Southern Vietnam. Participants were genotyped for APOB rs676210 using real-time polymerase chain reaction (PCR) with allele-specific probes. Lipid profile components, including LDL-C, high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and ApoB, were compared across genotype groups (AA vs GA/GG) and alleles (A vs G). Statistical analyses involved t tests, chi-square tests, and multivariable linear regression adjusted for age, sex, the BMI, and diabetes. P<.05 was considered statistically significant.

Results: Of the 69 participants, 32 (46.4%) carried the AA genotype, while 37 (53.6%) carried the GA or the GG genotype. The AA genotype was associated with significantly higher LDL-C (mean 5.19, SD 0.95, vs mean 4.37, SD 0.97, mmol/L; P<.001), non-HDL-C (mean 5.94, SD 1.08, vs mean 5.31, SD 1.22 mmol/L; P=.03), and ApoB (mean 149.5, SD 26.3, vs mean 136.9, SD 15.2, mg/dL; P=.02) and lower HDL-C (mean 1.26, SD 0.31, vs mean 1.44, SD 0.39, mmol/L; P=.03) compared to the GA/GG genotype. Allele-based analysis showed that carriers of the A allele (98/138, 71%) also had higher LDL-C (mean 4.91, SD 1.02, vs mean 4.36, SD 0.97, mmol/L; P=.004) and ApoB (mean 145.6, SD 23.2, vs mean 135.9, SD 16.0, mg/dL; P=.02) than G allele carriers (40/138, 29%). These associations remained significant after multivariate adjustment.

Conclusions: APOB rs676210 polymorphism is associated with significant differences in lipid profiles among Vietnamese adults with elevated LDL-C. Specifically, the A allele and the AA genotype confer a more atherogenic profile, suggesting potential utility as a genetic marker in lipid screening and personalized cardiovascular risk management in this population.

Background: Virtual reality (VR) has emerged as a promising, low-risk strategy to manage many forms of psychological stress and may be a modality to improve cardiovascular health. Recent scientific statements on the mind-heart-body connection call for better adherence to psychological screening and adoption of more holistic "behavioral cardiology" interventions that improve the overall health of patients with or at risk for cardiovascular disease (CVD).

Objective: The aim of this study is to assess safety and preliminarily explore how a VR experience can aid in stress reduction among patients with or at risk for CVD.

Methods: A convergent mixed methods approach was used for this single-arm prospective pilot study. In total, 20 patients were recruited from the University of California Los Angeles adult cardiology clinics and cardiac rehabilitation. Surveys and physiologic parameters were collected before, during, and after a 30-minute VR experience aimed at relaxation. The primary outcome was the State-Trait Anxiety Inventory-State (STAI-S) scale. They participated in a 90-minute visit, during which they completed surveys, including the STAI-S scale, before and after a 30-minute VR experience. Physiological parameters were also collected before, during, and after the experience. Visits concluded with semistructured interviews analyzed with inductive thematic analysis to add depth and nuance to our analysis.

Results: STAI-S scale scores after the VR experience were significantly decreased from baseline (median 31, IQR 28-38 vs median 24, IQR-29.25; P<.001). Verbal feedback revealed that participants experienced a relaxing sense of "distance from stress" moderated by unexpected, intense audiovisual components. Heart rate significantly decreased (mean 73, SD 8 vs mean 67, SD 6 beats per minute; P<.001), while blood pressure (mean systolic 128, SD 14 vs mean systolic 129, SD 18 mm Hg; P=.75 and mean diastolic 79, SD 9 vs mean diastolic 80, SD 10 mm Hg; P=.60) and galvanic skin response (mean 0.74, SD 0.89 vs mean 0.70, SD 0.57 microsiemens; P=.45) remained the same. Changes in heart rate variability parameters were consistent with increased vagal tone over time but were only statistically significant at certain time points. Survey results and interviews generally indicated safety, tolerability, and openness to using VR again.

Conclusions: This sample of patients with CVD or risk of CVD had above-average stress, consistent with epidemiological data; the statistically and clinically significant decrease in subjective perception of stress partially converged with physiologic data. Overall, the VR intervention was a safe and feasible stress reduction method. Future research is needed to evaluate the effectiveness of this immersive therapy in reducing cardiovascular risk profiles.

Background: Electronic clinical decision support systems (eCDSSs) are key to the digital transformation of health care. Despite their growing adoption, little is known about the perspectives of mental health clinicians on the implementation of eCDSS to assist them in managing physical health conditions within mental health care settings.

Objective: This study aimed to explore how clinicians in older adult mental health services manage stroke risk in patients with atrial fibrillation (AF) and comorbid serious mental illness who are admitted to the hospital under their care. It also sought to examine clinicians' views on the potential role of an eCDSS in enhancing stroke risk assessment and management.

Methods: A cross-sectional mixed methods study was conducted between March and May 2023 in 3 inpatient wards for mental health of older adults at South London and Maudsley NHS (National Health Service) Foundation Trust. Health care professionals, including psychiatrists and pharmacists, participated in a web-based survey and individual semistructured interviews. Ethical approval and informed consent were obtained. A descriptive analysis was conducted on the survey data, while interview data were analyzed thematically using an inductive approach.

Results: In total, 10 clinicians participated in the study. Thematic analysis revealed 2 primary themes. First, clinicians reported significant challenges in clinical practice, including difficulties accessing patient medical histories, limited expertise in managing physical health conditions, fragmented care pathways, and the impact of mental health symptoms such as psychotic beliefs on stroke prevention. Second, clinicians identified strategies to improve practice, such as embedding alerts in electronic records, establishing clear organizational policies, and providing tailored training on AF-related stroke management. Clinicians recognized the potential of an eCDSS to enhance clinical effectiveness, improve the identification of high-risk patients, ensure safer and more consistent care, and save time. However, they expressed concerns about potential risks, including rigidity in decision-making, overreliance on the tool, false positives, reduced critical thinking, annoyance, and increased workload.

Conclusions: This study highlights the challenges and opportunities in managing AF-related stroke risk in mental health settings. While clinicians acknowledged the potential of an eCDSS to improve care quality and efficiency, addressing concerns about its design and implementation is essential. These insights can inform the development of eCDSS tools that effectively balance benefits with user needs, ultimately improving patient outcomes in mental health services.

Background: Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has demonstrated many patient and health care system benefits. Consequently, the use of RM technology for patients with CIEDs is the standard of care as highlighted by international guidelines. However, RM has not yet been integrated into universal, routine clinical practice.

Objective: We aimed to establish key stakeholder perspectives on the barriers and enablers of CIED RM implementation and to apply the theoretical domain framework to highlight the most effective approaches to facilitate routine adoption of CIED RM.

Methods: This was a qualitative study, using semistructured interviews to explore the barriers and enablers encountered when incorporating RM into CIED management. Participants included cardiologists, cardiac clinicians or physiologists, nurses, and patients. Interviews were transcribed verbatim and analyzed through inductive thematic analysis and deductive approaches using the NVivo (version 14; QRS International Pty Ltd) software. The theoretical domains framework was used to understand barriers and enablers. In the inductive phase, we did not assess trustworthiness, as our thematic analysis approach views data as interpretations rather than objective truths. In the deductive phase, we conferred to ensure consistency in theme alignment with existing frameworks.

Results: Interviews were conducted among 35 participants (16 patients, 10 cardiologists, and 9 cardiac physiologists and nurses). We identified 5 main themes and their associated subthemes, with 1 representing an enabler and 4 representing barriers. They were: (1) patient benefits from RM, such as improved CIED and cardiovascular management, and improved patient-centered care; (2) insufficient allocation of CIED RM resources, which included insufficient RM clinic funding and staffing, insufficient RM service reimbursement, and RM infrastructure and access inequity; (3) suboptimal management of data, which includes inconsistent RM alert interpretation and management, lack of guidance for clinic staff on RM data management, and an increased alert burden for clinics; (4) insufficient patient education post-CIED implant, this was attributed to limited health care worker availability and resulted in inadequate patient CIED and RM knowledge postimplant and patient anxiety associated with RM; and (5) patient engagement with CIED management, which included the need for increased patient interaction with RM alerts and the ability to share data with patients. These subthemes were mapped to 6 specific domains of the theoretical domains framework: "Beliefs About Capabilities," "Environmental Context and Resources," "Beliefs About Consequences," "Knowledge," "Emotions," and "Goals."

Conclusions: Patient engagement was identified in 3 of the 5 themes describing barriers and enablers to RM. Th

Background: Heart failure management involves comprehensive lifestyle modifications such as daily weights, fluid and sodium restriction, and blood pressure monitoring, placing additional responsibility on patients and caregivers, with successful adherence often requiring extensive counseling and understandable patient education materials (PEMs). Prior research has shown PEMs related to cardiovascular disease often exceed the American Medical Association's fifth- to sixth-grade recommended reading level. The large language model (LLM) ChatGPT may be a useful tool for improving PEM readability.

Objective: We aim to assess the readability of heart failure-related PEMs from prominent cardiology institutions and evaluate GPT-4's ability to improve these metrics while maintaining accuracy and comprehensiveness.

Methods: A total of 143 heart failure-related PEMs were collected from the websites of the top 10 institutions listed on the 2022-2023 US News & World Report for "Best Hospitals for Cardiology, Heart & Vascular Surgery." PEMs were individually entered into GPT-4 (version updated July 20, 2023), preceded by the prompt, "Please explain the following in simpler terms." Readability was assessed using the Flesch Reading Ease score, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index, Coleman-Liau Index, Simple Measure of Gobbledygook Index, and Automated Readability Index. The accuracy and comprehensiveness of revised GPT-4 PEMs were assessed by a board-certified cardiologist.

Results: For 143 institutional heart failure-related PEMs analyzed, the median FKGL was 10.3 (IQR 7.9-13.1; high school sophomore) compared to 7.3 (IQR 6.1-8.5; seventh grade) for GPT-4's revised PEMs (P<.001). Of the 143 institutional PEMs, there were 13 (9.1%) below the sixth-grade reading level, which improved to 33 (23.1%) after revision by GPT-4 (P<.001). No revised GPT-4 PEMs were graded as less accurate or less comprehensive compared to institutional PEMs. A total of 33 (23.1%) GPT-4 PEMs were graded as more comprehensive.

Conclusions: GPT-4 significantly improved the readability of institutional heart failure-related PEMs. The model may be a promising adjunct resource in addition to care provided by a licensed health care professional for patients living with heart failure. Further rigorous testing and validation is needed to investigate its safety, efficacy, and impact on patient health literacy.

Background: Advances in digital technology, such as health apps and telerehabilitation systems, offer promising treatment modalities in the secondary prevention of cardiovascular disease. However, the successful adoption of digital technology in clinical practice depends on a variety of factors. A comprehensive understanding of the influencing factors on digital technology usage in health care can support the complex implementation process of digital technology in clinical practice.

Objective: The aim of this study was to identify barriers and facilitators of digital technology usage in cardiovascular disease secondary prevention from the perspective of health care professionals, and to explore whether certain characteristics of health care professionals are related to the current usage of digital technology in clinical practice.

Methods: We conducted an exploratory online survey, inquiring about the perspectives and uses of digital technologies in cardiovascular disease secondary prevention. We developed an original questionnaire to address the study aim. The survey invitation was distributed among health care professionals from November 2021 to February 2022, via all cardiac rehabilitation centers, all community-based disease management services for patients with chronic heart failure, and all relevant national health care professional associations in Austria. Qualitative survey data were analyzed using thematic content analysis. Quantitative survey data were analyzed using descriptive statistics, group comparison tests, and association statistics.

Results: Overall, 125 health care professionals (mean age 41, SD 11 y; n=80, 64% females) across different professions and settings, including cardiac rehabilitation phases I through IV, were recruited. General readiness for using digital technologies in the care of cardiac patients was high, but only 65 (52%) respondents reported doing so. The top 3 rated barriers to digital technology use were poor user-experience of devices and apps, lack of cost coverage, and low digital competence of patients. The top 3 rated potential application areas for digital technology were organization and appointment planning, documenting treatments, and creating personalized treatment plans. The top 3 rated facilitators for digital technology use were assurance of patient safety, assurance of patients' privacy, and availability of technical support. Greater personal use of digital technology, younger age, and higher technology affinity of health care professionals was associated with higher readiness to use digital technology with cardiac patients.

Conclusions: While there is interest in digital technology for the secondary prevention of cardiovascular disease in Austria, barriers to uptake need to be addressed. Our findings may inform the design and implementation of future digitalization projects.