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A smartwatch-based CPR feedback device improves chest compression quality among health care professionals and lay rescuers 基于智能手表的心肺复苏反馈设备可提高医护人员和非专业救援人员的胸外按压质量
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cvdhj.2024.03.006
Adam S. LaPrad PhD , Bridgid Joseph DPN, RN, CCNS , Sara Chokshi PhD , Kelly Aldrich DNP, MS, RN-BC , David Kessler MD, MSc , Beno W. Oppenheimer MD

Background

Cardiopulmonary resuscitation (CPR) quality significantly impacts patient outcomes during cardiac arrests. With advancements in health care technology, smartwatch-based CPR feedback devices have emerged as potential tools to enhance CPR delivery.

Objective

This study evaluated a novel smartwatch-based CPR feedback device in enhancing chest compression quality among health care professionals and lay rescuers.

Methods

A single-center, open-label, randomized crossover study was conducted with 30 subjects categorized into 3 groups based on rescuer category. The Relay Response BLS smartwatch application was compared to a defibrillator-based feedback device (Zoll OneStep CPR Pads). Following an introduction to the technology, subjects performed chest compressions in 3 modules: baseline unaided, aided by the smartwatch-based feedback device, and aided by the defibrillator-based feedback device. Outcome measures included effectiveness, learnability, and usability.

Results

Across all groups, the smartwatch-based device significantly improved mean compression depth effectiveness (68.4% vs 29.7%; P < .05) and mean rate effectiveness (87.5% vs 30.1%; P < .05), compared to unaided compressions. Compression variability was significantly reduced with the smartwatch-based device (coefficient of variation: 14.9% vs 26.6%), indicating more consistent performance. Fifteen of 20 professional rescuers reached effective compressions using the smartwatch-based device in an average 2.6 seconds. A usability questionnaire revealed strong preference for the smartwatch-based device over the defibrillator-based device.

Conclusion

The smartwatch-based device enhances the quality of CPR delivery by keeping compressions within recommended ranges and reducing performance variability. Its user-friendliness and rapid learnability suggest potential for widespread adoption in both professional and lay rescuer scenarios, contributing positively to CPR training and real-life emergency responses.

背景心肺复苏(CPR)的质量对心脏骤停患者的预后有重大影响。随着医疗保健技术的进步,基于智能手表的心肺复苏反馈设备已成为提高心肺复苏实施质量的潜在工具。本研究评估了基于智能手表的新型心肺复苏反馈设备在提高医疗保健专业人员和非专业施救者胸外按压质量方面的作用。Relay Response BLS 智能手表应用与除颤仪反馈设备(Zoll OneStep CPR Pads)进行了比较。在对技术进行介绍后,受试者在 3 个模块中进行胸外按压:基线无辅助、基于智能手表的反馈设备辅助和基于除颤仪的反馈设备辅助。结果在所有组别中,与无辅助按压相比,基于智能手表的设备显著提高了平均按压深度效果(68.4% vs 29.7%; P <.05)和平均按压频率效果(87.5% vs 30.1%; P <.05)。基于智能手表的设备大大降低了按压的变异性(变异系数:14.9% vs 26.6%),表明其性能更加稳定。在 20 名专业救援人员中,有 15 人使用智能手表设备在平均 2.6 秒内实现了有效按压。可用性问卷调查显示,与除颤器设备相比,智能手表设备更受青睐。 结论:智能手表设备可将按压次数控制在推荐范围内,并减少性能变化,从而提高心肺复苏的质量。它的用户友好性和快速可学性表明,它有可能在专业和非专业救援人员的场景中得到广泛应用,为心肺复苏培训和现实生活中的应急响应做出积极贡献。
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引用次数: 0
Point-of-care testing preferences 2020–2022: Trends over the years 2020-2022 年护理点检测偏好:历年趋势
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cvdhj.2024.03.002
Sakeina Howard-Wilson DO , Ziyue Wang , Taylor Orwig , Denise Dunlap MS, PhD , Nathaniel Hafer PhD , Bryan Buchholz PhD , Shiv Sutaria MD , David D. McManus MD, ScM , Craig M. Lilly MD

Background

The use of point-of-care (POC) tests prior to the COVID-19 pandemic was relatively infrequent outside of the health care context. Little is known about how public opinions regarding POC tests have changed during the pandemic.

Methods

We redeployed a validated survey to uncompensated volunteers to assess preferences for point-of-care testing (POCT) benefits and concerns between June and September 2022. We received a total of 292 completed surveys. Linear regression analysis was used to compare differences in survey average response scores (ARSs) from 2020 to 2022.

Results

Respondent ARSs indicated agreement for all 16 POCT benefits in 2022. Of 14 POCT concerns, there were only 2 statements that respondents agreed with most frequently, which were that “Insurance might not cover the costs of the POC test” (ARS 0.9, ± 1.0) and “POC tests might not provide a definitive result” (ARS 0.1, ± 1.0). Additionally, when comparing survey responses from 2020 to 2022, we observed 8 significant trends for POCT harms and benefits.

Conclusion

The public’s opinion on POC tests has become more favorable over time. However, concerns regarding the affordability and reliability of POCT results persist. We suggest that stakeholders address these concerns by developing accurate POC tests that continue to improve care and facilitate access to health care for all.

背景在COVID-19大流行之前,护理点检测(POC)的使用在医疗保健领域之外相对较少。我们在 2022 年 6 月至 9 月期间对无偿志愿者重新进行了一次有效调查,以评估他们对护理点检测(POCT)益处和担忧的偏好。我们共收到 292 份完成的调查问卷。我们使用线性回归分析法比较了 2020 年至 2022 年调查平均响应得分(ARS)的差异。结果受访者的 ARS 显示,他们同意 2022 年所有 16 项 POCT 优点。在 14 项 POCT 关切中,受访者最常同意的只有 2 项陈述,即 "保险可能不包括 POC 检测的费用"(ARS 0.9,± 1.0)和 "POC 检测可能无法提供明确结果"(ARS 0.1,± 1.0)。此外,在比较 2020 年至 2022 年的调查回复时,我们观察到关于 POCT 危害和益处的 8 个显著趋势。然而,人们对 POCT 检测结果的可负担性和可靠性的担忧依然存在。我们建议利益相关者通过开发准确的 POC 检验来解决这些问题,从而继续改善医疗服务,方便所有人获得医疗服务。
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引用次数: 0
Determinants of global cardiac implantable electrical device remote monitoring utilization – Results from an international survey 全球心脏植入式电子设备远程监控使用情况的决定因素 - 一项国际调查的结果
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cvdhj.2024.03.003
Bert Vandenberk MD, PhD , Neal Ferrick MD , Elaine Y. Wan MD , Sanjiv M. Narayan MD, PhD , Aileen M. Ferrick PhD , Satish R. Raj MD, MSCI

Background

Despite near-global availability of remote monitoring (RM) in patients with cardiac implantable electronic devices (CIED), there is a high geographical variability in the uptake and use of RM. The underlying reasons for this geographic disparity remain largely unknown.

Objectives

To study the determinants of worldwide RM utilization and identify locoregional barriers of RM uptake.

Methods

An international survey was administered to all CIED clinic personnel using the Heart Rhythm Society global network collecting demographic information, as well as information on the use of RM, the organization of the CIED clinic, and details on local reimbursement and clinic funding. The most complete response from each center was included in the current analysis. Stepwise forward multivariate linear regression was performed to identify determinants of the percentage of patients with a CIED on RM.

Results

A total of 302 responses from 47 different countries were included, 61.3% by physicians and 62.3% from hospital-based CIED clinics. The median percentage of CIED patients on RM was 80% (interquartile range, 40–90). Predictors of RM use were gross national income per capita (0.76% per US$1000, 95% CI 0.72–1.00, P < .001), office-based clinics (7.48%, 95% CI 1.53–13.44, P = .014), and presence of clinic funding (per-patient payment model 7.90% [95% CI 0.63–15.17, P = .033); global budget 3.56% (95% CI -6.14 to 13.25, P = .471]).

Conclusion

The high variability in RM utilization can partly be explained by economic and structural barriers that may warrant specific efforts by all stakeholders to increase RM utilization.

背景尽管远程监护(RM)在心脏植入式电子装置(CIED)患者中的应用几乎遍及全球,但在RM的吸收和使用方面却存在很大的地域差异。方法利用心律协会全球网络对所有 CIED 诊所人员进行国际调查,收集人口统计学信息、RM 使用情况、CIED 诊所组织情况以及当地报销和诊所资金的详细信息。每个中心最完整的回复都纳入了本次分析。结果 共有来自 47 个不同国家的 302 份回复被纳入分析,其中 61.3% 来自医生,62.3% 来自医院的 CIED 诊所。使用RM的CIED患者比例中位数为80%(四分位距为40-90)。使用 RM 的预测因素包括人均国民总收入(每 1000 美元 0.76%,95% CI 0.72-1.00,P < .001)、诊所(7.48%,95% CI 1.53-13.44,P = .014)和诊所资金(按患者付费模式 7.90% [95% CI 0.63-15.结论 RM 利用率的高差异可部分归因于经济和结构性障碍,这可能需要所有利益相关者为提高 RM 利用率做出具体努力。
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引用次数: 0
Use of digital health technologies in periprocedural pediatric cardiac ablation 在围手术期儿科心脏消融术中使用数字医疗技术
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cvdhj.2024.03.004
Nathan Miller RN , David Catherall MEng , Anthony G. Pompa MD , Lisa Roelle PA-C , Tracy Conner MD , William B. Orr MD , Jennifer N. Avari Silva MD
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引用次数: 0
Feasibility of remote monitoring for fatal coronary heart disease using Apple Watch ECGs 使用 Apple Watch 心电图远程监测致命冠心病的可行性
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cvdhj.2024.03.007
Liam Butler PhD , Alexander Ivanov MD , Turgay Celik MD , Ibrahim Karabayir PhD , Lokesh Chinthala MS , Melissa M. Hudson MD , Kiri K. Ness PhD , Daniel A. Mulrooney MD, MS , Stephanie B. Dixon MD, MPH , Mohammad S. Tootooni PhD , Adam J. Doerr MD , Byron C. Jaeger PhD , Robert L. Davis MD, MPH , David D. McManus MD, ScM , David Herrington MD, MHS , Oguz Akbilgic DBA, PhD

Background

Fatal coronary heart disease (FCHD) is often described as sudden cardiac death (affects >4 million people/year), where coronary artery disease is the only identified condition. Electrocardiographic artificial intelligence (ECG-AI) models for FCHD risk prediction using ECG data from wearable devices could enable wider screening/monitoring efforts.

Objectives

To develop a single-lead ECG–based deep learning model for FCHD risk prediction and assess concordance between clinical and Apple Watch ECGs.

Methods

An FCHD single-lead (“lead I” from 12-lead ECGs) ECG-AI model was developed using 167,662 ECGs (50,132 patients) from the University of Tennessee Health Sciences Center. Eighty percent of the data (5-fold cross-validation) was used for training and 20% as a holdout. Cox proportional hazards (CPH) models incorporating ECG-AI predictions with age, sex, and race were also developed. The models were tested on paired clinical single-lead and Apple Watch ECGs from 243 St. Jude Lifetime Cohort Study participants. The correlation and concordance of the predictions were assessed using Pearson correlation (R), Spearman correlation (ρ), and Cohen’s kappa.

Results

The ECG-AI and CPH models resulted in AUC = 0.76 and 0.79, respectively, on the 20% holdout and AUC = 0.85 and 0.87 on the Atrium Health Wake Forest Baptist external validation data. There was moderate-strong positive correlation between predictions (R = 0.74, ρ = 0.67, and κ = 0.58) when tested on the 243 paired ECGs. The clinical (lead I) and Apple Watch predictions led to the same low/high-risk FCHD classification for 99% of the participants. CPH prediction correlation resulted in an R = 0.81, ρ = 0.76, and κ = 0.78.

Conclusion

Risk of FCHD can be predicted from single-lead ECGs obtained from wearable devices and are statistically concordant with lead I of a 12-lead ECG.

背景致命性冠心病(FCHD)通常被描述为心脏性猝死(每年影响>400万人),其中冠状动脉疾病是唯一确定的疾病。方法利用田纳西大学健康科学中心的167662份心电图(50132名患者)开发了FCHD单导联(12导联心电图中的 "I导联")心电图人工智能模型。其中 80% 的数据(5 倍交叉验证)用于训练,20% 作为保留数据。此外,还开发了将心电图 AI 预测与年龄、性别和种族相结合的 Cox 比例危险(CPH)模型。这些模型在 243 名圣犹达终生队列研究参与者的配对临床单导联和 Apple Watch 心电图上进行了测试。使用皮尔逊相关性(R)、斯皮尔曼相关性(ρ)和科恩卡帕(Cohen's kappa)对预测的相关性和一致性进行了评估。结果ECG-AI和CPH模型在20%保留率数据上的AUC分别为0.76和0.79,在Atrium Health Wake Forest Baptist外部验证数据上的AUC分别为0.85和0.87。在 243 张配对心电图上进行测试时,预测结果之间存在中等强度的正相关性(R = 0.74、ρ = 0.67 和 κ = 0.58)。在 99% 的参与者中,临床预测(导联 I)和 Apple Watch 预测得出的 FCHD 低/高风险分类结果相同。CPH 预测相关性的 R = 0.81、ρ = 0.76 和 κ = 0.78。
{"title":"Feasibility of remote monitoring for fatal coronary heart disease using Apple Watch ECGs","authors":"Liam Butler PhD ,&nbsp;Alexander Ivanov MD ,&nbsp;Turgay Celik MD ,&nbsp;Ibrahim Karabayir PhD ,&nbsp;Lokesh Chinthala MS ,&nbsp;Melissa M. Hudson MD ,&nbsp;Kiri K. Ness PhD ,&nbsp;Daniel A. Mulrooney MD, MS ,&nbsp;Stephanie B. Dixon MD, MPH ,&nbsp;Mohammad S. Tootooni PhD ,&nbsp;Adam J. Doerr MD ,&nbsp;Byron C. Jaeger PhD ,&nbsp;Robert L. Davis MD, MPH ,&nbsp;David D. McManus MD, ScM ,&nbsp;David Herrington MD, MHS ,&nbsp;Oguz Akbilgic DBA, PhD","doi":"10.1016/j.cvdhj.2024.03.007","DOIUrl":"10.1016/j.cvdhj.2024.03.007","url":null,"abstract":"<div><h3>Background</h3><p>Fatal coronary heart disease (FCHD) is often described as sudden cardiac death (affects &gt;4 million people/year), where coronary artery disease is the only identified condition. Electrocardiographic artificial intelligence (ECG-AI) models for FCHD risk prediction using ECG data from wearable devices could enable wider screening/monitoring efforts.</p></div><div><h3>Objectives</h3><p>To develop a single-lead ECG–based deep learning model for FCHD risk prediction and assess concordance between clinical and Apple Watch ECGs.</p></div><div><h3>Methods</h3><p>An FCHD single-lead (“lead I” from 12-lead ECGs) ECG-AI model was developed using 167,662 ECGs (50,132 patients) from the University of Tennessee Health Sciences Center. Eighty percent of the data (5-fold cross-validation) was used for training and 20% as a holdout. Cox proportional hazards (CPH) models incorporating ECG-AI predictions with age, sex, and race were also developed. The models were tested on paired clinical single-lead and Apple Watch ECGs from 243 St. Jude Lifetime Cohort Study participants. The correlation and concordance of the predictions were assessed using Pearson correlation (R), Spearman correlation (ρ), and Cohen’s kappa.</p></div><div><h3>Results</h3><p>The ECG-AI and CPH models resulted in AUC = 0.76 and 0.79, respectively, on the 20% holdout and AUC = 0.85 and 0.87 on the Atrium Health Wake Forest Baptist external validation data. There was moderate-strong positive correlation between predictions (R = 0.74, ρ = 0.67, and κ = 0.58) when tested on the 243 paired ECGs. The clinical (lead I) and Apple Watch predictions led to the same low/high-risk FCHD classification for 99% of the participants. CPH prediction correlation resulted in an R = 0.81, ρ = 0.76, and κ = 0.78.</p></div><div><h3>Conclusion</h3><p>Risk of FCHD can be predicted from single-lead ECGs obtained from wearable devices and are statistically concordant with lead I of a 12-lead ECG.</p></div>","PeriodicalId":72527,"journal":{"name":"Cardiovascular digital health journal","volume":"5 3","pages":"Pages 115-121"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666693624000306/pdfft?md5=75e33d0289fa6cf13b0db8075297b6a9&pid=1-s2.0-S2666693624000306-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140780704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Artificial intelligence–based screening for cardiomyopathy in an obstetric population: A pilot study 基于人工智能的产科人群心肌病筛查:试点研究
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cvdhj.2024.03.005
Demilade Adedinsewo MD, MPH , Andrea Carolina Morales-Lara MD , Heather Hardway PhD , Patrick Johnson BS , Kathleen A. Young MD , Wendy Tatiana Garzon-Siatoya MD , Yvonne S. Butler Tobah MD , Carl H. Rose MD , David Burnette BS , Kendra Seccombe APRN , Mia Fussell BS , Sabrina Phillips MD , Francisco Lopez-Jimenez MD , Zachi I. Attia PhD , Paul A. Friedman MD , Rickey E. Carter PhD , Peter A. Noseworthy MD

Background

Cardiomyopathy is a leading cause of pregnancy-related mortality and the number one cause of death in the late postpartum period. Delay in diagnosis is associated with severe adverse outcomes.

Objective

To evaluate the performance of an artificial intelligence–enhanced electrocardiogram (AI-ECG) and AI-enabled digital stethoscope to detect left ventricular systolic dysfunction in an obstetric population.

Methods

We conducted a single-arm prospective study of pregnant and postpartum women enrolled at 3 sites between October 28, 2021, and October 27, 2022. Study participants completed a standard 12-lead ECG, digital stethoscope ECG and phonocardiogram recordings, and a transthoracic echocardiogram within 24 hours. Diagnostic performance was evaluated using the area under the curve (AUC).

Results

One hundred women were included in the final analysis. The median age was 31 years (Q1: 27, Q3: 34). Thirty-eight percent identified as non-Hispanic White, 32% as non-Hispanic Black, and 21% as Hispanic. Five percent and 6% had left ventricular ejection fraction (LVEF) <45% and <50%, respectively. The AI-ECG model had near-perfect classification performance (AUC: 1.0, 100% sensitivity; 99%–100% specificity) for detection of cardiomyopathy at both LVEF categories. The AI-enabled digital stethoscope had an AUC of 0.98 (95% CI: 0.95, 1.00) and 0.97 (95% CI: 0.93, 1.00), for detection of LVEF <45% and <50%, respectively, with 100% sensitivity and 90% specificity.

Conclusion

We demonstrate an AI-ECG and AI-enabled digital stethoscope were effective for detecting cardiac dysfunction in an obstetric population. Larger studies, including an evaluation of the impact of screening on clinical outcomes, are essential next steps.

背景心肌病是妊娠相关死亡的主要原因,也是产后晚期的头号死因。目标评估人工智能增强型心电图(AI-ECG)和人工智能数字听诊器在产科人群中检测左心室收缩功能障碍的性能。方法我们对 2021 年 10 月 28 日至 2022 年 10 月 27 日期间在 3 个地点注册的孕妇和产后妇女进行了一项单臂前瞻性研究。研究参与者在 24 小时内完成了标准 12 导联心电图、数字听诊器心电图和声心动图记录以及经胸超声心动图检查。诊断性能采用曲线下面积(AUC)进行评估。中位年龄为 31 岁(第一季度:27 岁,第三季度:34 岁)。38%为非西班牙裔白人,32%为非西班牙裔黑人,21%为西班牙裔。左心室射血分数(LVEF)为 45% 和 50% 的分别占 5% 和 6%。人工智能心电图模型的分类性能接近完美(AUC:1.0,灵敏度100%;特异度99%-100%),可检测出两个LVEF类别的心肌病。人工智能数字听诊器在检测 LVEF 45% 和 50% 时的 AUC 分别为 0.98 (95% CI: 0.95, 1.00) 和 0.97 (95% CI: 0.93, 1.00),灵敏度为 100%,特异度为 90%。下一步必须进行更大规模的研究,包括评估筛查对临床结果的影响。
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引用次数: 0
Cellular-Enabled Remote Patient Monitoring for Pregnancies Complicated by Hypertension 对妊娠并发高血压的手机远程患者监控
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cvdhj.2024.03.001
Rebecca D. Jones MPH, Cheng Peng PhD, MPA, MS, Crystal D. Jones RDCS, MHS, Brianna Long MS, Victoria Helton MD, Hari Eswaran PhD

Introduction

Unmanaged hypertension in pregnancy is the second most common cause of direct maternal death and disproportionately affects women in rural areas. While telehealth technologies have worked to reduce barriers to healthcare, lack of internet access has created new challenges. Cellular-enabled remote patient monitoring devices provide an alternative option for those without access to internet.

Objective

This study aimed to assess maternal and neonatal clinical outcomes and patient acceptability of an integrated model of cellular-enabled remote patient monitoring devices for blood pressure supported by a 24/7 nurse call center.

Methods

In a mixed-methods study, 20 women with hypertension during pregnancy were given a cellular-enabled BodyTrace blood pressure cuff. Participants’ blood pressures were continuously monitored by a nurse call center. Participants completed a baseline survey, post-survey, and semi-structured interview after 8 weeks of device use.

Results

Participants reported a significant decrease in perceived stress after device use (P = .0004), high satisfaction with device usability (mean = 78.38, SD = 13.68), and high intention to continue device use (mean = 9.05, SD = 1.96). Relatively low hospitalization and emergency department rates was observed (mean = 0.35, SD = 0.59; mean = 0.75, SD = 0.91). Participant-perceived benefits of device use included convenience, perceived better care owing to increased monitoring, and patient empowerment. Perceived disadvantages included higher blood pressure readings compared to clinical readings and excessive calls from call center.

Conclusion

Remote patient monitoring for women whose pregnancies are complicated by hypertension can reduce barriers and improve health outcomes for women living in rural and low-health-resource areas.

导言:未经管理的妊娠高血压是导致孕产妇直接死亡的第二大常见原因,对农村地区妇女的影响尤为严重。虽然远程医疗技术已在减少医疗障碍方面发挥了作用,但缺乏互联网接入却带来了新的挑战。本研究旨在评估孕产妇和新生儿的临床结果,以及患者对由全天候护士呼叫中心支持的远程血压监测设备综合模式的接受程度。方法在一项混合方法研究中,20 名妊娠期高血压妇女获得了一个支持手机的 BodyTrace 血压袖带。护士呼叫中心对参与者的血压进行持续监测。参与者在使用设备 8 周后完成了基线调查、后期调查和半结构式访谈。结果参与者报告称,使用设备后感知到的压力显著降低(P = 0.0004),对设备可用性的满意度高(平均值 = 78.38,标准差 = 13.68),继续使用设备的意愿高(平均值 = 9.05,标准差 = 1.96)。住院率和急诊率相对较低(平均 = 0.35,标准差 = 0.59;平均 = 0.75,标准差 = 0.91)。参与者认为使用血压计的好处包括方便、可通过加强监测获得更好的护理以及增强患者的能力。结论对妊娠合并高血压的妇女进行远程患者监测可以减少障碍,改善农村和低卫生资源地区妇女的健康状况。
{"title":"Cellular-Enabled Remote Patient Monitoring for Pregnancies Complicated by Hypertension","authors":"Rebecca D. Jones MPH,&nbsp;Cheng Peng PhD, MPA, MS,&nbsp;Crystal D. Jones RDCS, MHS,&nbsp;Brianna Long MS,&nbsp;Victoria Helton MD,&nbsp;Hari Eswaran PhD","doi":"10.1016/j.cvdhj.2024.03.001","DOIUrl":"10.1016/j.cvdhj.2024.03.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Unmanaged hypertension in pregnancy is the second most common cause of direct maternal death and disproportionately affects women in rural areas. While telehealth technologies have worked to reduce barriers to healthcare, lack of internet access has created new challenges. Cellular-enabled remote patient monitoring devices provide an alternative option for those without access to internet.</p></div><div><h3>Objective</h3><p>This study aimed to assess maternal and neonatal clinical outcomes and patient acceptability of an integrated model of cellular-enabled remote patient monitoring devices for blood pressure supported by a 24/7 nurse call center.</p></div><div><h3>Methods</h3><p>In a mixed-methods study, 20 women with hypertension during pregnancy were given a cellular-enabled BodyTrace blood pressure cuff. Participants’ blood pressures were continuously monitored by a nurse call center. Participants completed a baseline survey, post-survey, and semi-structured interview after 8 weeks of device use.</p></div><div><h3>Results</h3><p>Participants reported a significant decrease in perceived stress after device use (<em>P</em> = .0004), high satisfaction with device usability (mean = 78.38, SD = 13.68), and high intention to continue device use (mean = 9.05, SD = 1.96). Relatively low hospitalization and emergency department rates was observed (mean = 0.35, SD = 0.59; mean = 0.75, SD = 0.91). Participant-perceived benefits of device use included convenience, perceived better care owing to increased monitoring, and patient empowerment. Perceived disadvantages included higher blood pressure readings compared to clinical readings and excessive calls from call center.</p></div><div><h3>Conclusion</h3><p>Remote patient monitoring for women whose pregnancies are complicated by hypertension can reduce barriers and improve health outcomes for women living in rural and low-health-resource areas.</p></div>","PeriodicalId":72527,"journal":{"name":"Cardiovascular digital health journal","volume":"5 3","pages":"Pages 156-163"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666693624000136/pdfft?md5=19a64676a8ec4cb896ee85b8bac0b90a&pid=1-s2.0-S2666693624000136-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140274982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between amount of biventricular pacing and heart failure status measured by a multisensor implantable defibrillator algorithm 多传感器植入式除颤器算法测量的双心室起搏量与心衰状态之间的关系
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1016/j.cvdhj.2024.02.005
Luca Santini MD , Leonardo Calò MD , Antonio D’Onofrio MD , Michele Manzo MD , Antonio Dello Russo MD , Gianluca Savarese MD , Domenico Pecora MD , Claudia Amellone MD , Vincenzo Ezio Santobuono MD, PhD , Raimondo Calvanese MD , Miguel Viscusi MD , Ennio Pisanò MD , Antonio Pangallo MD , Antonio Rapacciuolo MD , Matteo Bertini MD, PhD , Carlo Lavalle MD , Amato Santoro MD , Monica Campari MS , Sergio Valsecchi PhD , Giuseppe Boriani MD, PhD

Background

Achieving a high biventricular pacing percentage (BiV%) is crucial for optimizing outcomes in cardiac resynchronization therapy (CRT). The HeartLogic index, a multiparametric heart failure (HF) risk score, incorporates implantable cardioverter-defibrillator (ICD)-measured variables and has demonstrated its predictive ability for impending HF decompensation.

Objective

This study aimed to investigate the relationship between daily BiV% in CRT ICD patients and their HF status, assessed using the HeartLogic algorithm.

Methods

The HeartLogic algorithm was activated in 306 patients across 26 centers, with a median follow-up of 26 months (25th–75th percentile: 15–37).

Results

During the follow-up period, 619 HeartLogic alerts were recorded in 186 patients. Overall, daily values associated with the best clinical status (highest first heart sound, intrathoracic impedance, patient activity; lowest combined index, third heart sound, respiration rate, night heart rate) were associated with a BiV% exceeding 99%. We identified 455 instances of BiV% dropping below 98% after consistent pacing periods. Longer episodes of reduced BiV% (hazard ratio: 2.68; 95% CI: 1.02–9.72; P = .045) and lower BiV% (hazard ratio: 3.97; 95% CI: 1.74–9.06; P=.001) were linked to a higher risk of HeartLogic alerts. BiV% drops exceeding 7 days predicted alerts with 90% sensitivity (95% CI [74%–98%]) and 55% specificity (95% CI [51%–60%]), while BiV% ≤96% predicted alerts with 74% sensitivity (95% CI [55%–88%]) and 81% specificity (95% CI [77%–85%]).

Conclusion

A clear correlation was observed between reduced daily BiV% and worsening clinical conditions, as indicated by the HeartLogic index. Importantly, even minor reductions in pacing percentage and duration were associated with an increased risk of HF alerts.

背景达到较高的双心室起搏率(BiV%)对于优化心脏再同步化治疗(CRT)的疗效至关重要。本研究旨在调查 CRT ICD 患者每日 BiV% 与其 HF 状态之间的关系,该状态使用 HeartLogic 算法进行评估。结果在随访期间,186 名患者记录了 619 次 HeartLogic 警报。总体而言,与最佳临床状态相关的每日值(最高的第一心音、胸内阻抗、患者活动;最低的综合指数、第三心音、呼吸频率、夜间心率)与超过 99% 的 BiV% 相关。我们发现有 455 例 BiV% 在持续起搏后降至 98% 以下的情况。较长时间的 BiV% 下降(危险比:2.68;95% CI:1.02-9.72;P=0.045)和较低的 BiV% 下降(危险比:3.97;95% CI:1.74-9.06;P=0.001)与较高的 HeartLogic 警报风险有关。BiV% 下降超过 7 天预测警报的灵敏度为 90%(95% CI [74%-98%]),特异度为 55%(95% CI [51%-60%]),而 BiV%≤96% 预测警报的灵敏度为 74%(95% CI [55%-88%]),特异度为 81%(95% CI [77%-85%])。重要的是,即使起搏比例和持续时间略有减少,也会增加高频警报的风险。
{"title":"Association between amount of biventricular pacing and heart failure status measured by a multisensor implantable defibrillator algorithm","authors":"Luca Santini MD ,&nbsp;Leonardo Calò MD ,&nbsp;Antonio D’Onofrio MD ,&nbsp;Michele Manzo MD ,&nbsp;Antonio Dello Russo MD ,&nbsp;Gianluca Savarese MD ,&nbsp;Domenico Pecora MD ,&nbsp;Claudia Amellone MD ,&nbsp;Vincenzo Ezio Santobuono MD, PhD ,&nbsp;Raimondo Calvanese MD ,&nbsp;Miguel Viscusi MD ,&nbsp;Ennio Pisanò MD ,&nbsp;Antonio Pangallo MD ,&nbsp;Antonio Rapacciuolo MD ,&nbsp;Matteo Bertini MD, PhD ,&nbsp;Carlo Lavalle MD ,&nbsp;Amato Santoro MD ,&nbsp;Monica Campari MS ,&nbsp;Sergio Valsecchi PhD ,&nbsp;Giuseppe Boriani MD, PhD","doi":"10.1016/j.cvdhj.2024.02.005","DOIUrl":"https://doi.org/10.1016/j.cvdhj.2024.02.005","url":null,"abstract":"<div><h3>Background</h3><p>Achieving a high biventricular pacing percentage (BiV%) is crucial for optimizing outcomes in cardiac resynchronization therapy (CRT). The HeartLogic index, a multiparametric heart failure (HF) risk score, incorporates implantable cardioverter-defibrillator (ICD)-measured variables and has demonstrated its predictive ability for impending HF decompensation.</p></div><div><h3>Objective</h3><p>This study aimed to investigate the relationship between daily BiV% in CRT ICD patients and their HF status, assessed using the HeartLogic algorithm.</p></div><div><h3>Methods</h3><p>The HeartLogic algorithm was activated in 306 patients across 26 centers, with a median follow-up of 26 months (25th–75th percentile: 15–37).</p></div><div><h3>Results</h3><p>During the follow-up period, 619 HeartLogic alerts were recorded in 186 patients. Overall, daily values associated with the best clinical status (highest first heart sound, intrathoracic impedance, patient activity; lowest combined index, third heart sound, respiration rate, night heart rate) were associated with a BiV% exceeding 99%. We identified 455 instances of BiV% dropping below 98% after consistent pacing periods. Longer episodes of reduced BiV% (hazard ratio: 2.68; 95% CI: 1.02–9.72; <em>P</em> = .045) and lower BiV% (hazard ratio: 3.97; 95% CI: 1.74–9.06; <em>P</em>=.001) were linked to a higher risk of HeartLogic alerts. BiV% drops exceeding 7 days predicted alerts with 90% sensitivity (95% CI [74%–98%]) and 55% specificity (95% CI [51%–60%]), while BiV% ≤96% predicted alerts with 74% sensitivity (95% CI [55%–88%]) and 81% specificity (95% CI [77%–85%]).</p></div><div><h3>Conclusion</h3><p>A clear correlation was observed between reduced daily BiV% and worsening clinical conditions, as indicated by the HeartLogic index. Importantly, even minor reductions in pacing percentage and duration were associated with an increased risk of HF alerts.</p></div>","PeriodicalId":72527,"journal":{"name":"Cardiovascular digital health journal","volume":"5 3","pages":"Pages 164-172"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666693624000124/pdfft?md5=601cba59beb6c2265565914c3c53d6ca&pid=1-s2.0-S2666693624000124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141424468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Can eHealth programs for cardiac arrhythmias be scaled-up by using the KardiaMobile algorithm? 使用 KardiaMobile 算法能否扩大心律失常电子健康计划的规模?
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 DOI: 10.1016/j.cvdhj.2023.11.004
Bridget M.I. Slaats Bsc , Sebastiaan Blok PhD , G. Aernout Somsen MD, PhD , Igor I. Tulevski MD, PhD , Reinoud E. Knops MD, PhD, FHRS , Bert-Jan H. van den Born MD, PhD , Michiel M. Winter MD, PhD

Background

Remote monitoring devices for atrial fibrillation are known to positively contribute to the diagnostic process and therapy compliance. However, automatic algorithms within devices show varying sensitivity and specificity, so manual double-checking of electrocardiographic (ECG) recordings remains necessary.

Objective

The purpose of this study was to investigate the validity of the KardiaMobile algorithm within the Dutch telemonitoring program (HartWacht).

Methods

This retrospective study determined the diagnostic accuracy of the algorithm using assessments by a telemonitoring team as reference. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and F1 scores were determined.

Results

A total of 2298 patients (59.5% female; median age 57 ± 15 years) recorded 86,816 ECGs between April 2019 and January 2021. The algorithm showed sensitivity of 0.956, specificity 0.985, PPV 0.996, NPV 0.847, and F1 score 0.976 for the detection of sinus rhythm. A total of 29 false-positive outcomes remained uncorrected within the same patients. The algorithm showed sensitivity of 0.989, specificity 0.953, PPV 0.835, NPV 0.997, and F1 score 0.906 for detection of atrial fibrillation. A total of 2 false-negative outcomes remained uncorrected.

Conclusion

Our research showed high validity of the algorithm for the detection of both sinus rhythm and, to a lesser extent, atrial fibrillation. This finding suggests that the algorithm could function as a standalone instrument particularly for detection of sinus rhythm.

背景众所周知,心房颤动远程监测设备对诊断过程和治疗依从性有积极的促进作用。本研究的目的是调查 KardiaMobile 算法在荷兰远程监护计划 (HartWacht) 中的有效性。方法这项回顾性研究以远程监护团队的评估为参考,确定了算法的诊断准确性。结果在 2019 年 4 月至 2021 年 1 月期间,共有 2298 名患者(59.5% 为女性;中位年龄为 57±15 岁)记录了 86816 张心电图。该算法检测窦性心律的灵敏度为 0.956,特异性为 0.985,PPV 为 0.996,NPV 为 0.847,F1 得分为 0.976。同一患者中共有 29 例假阳性结果未得到纠正。该算法检测心房颤动的灵敏度为 0.989,特异性为 0.953,PPV 为 0.835,NPV 为 0.997,F1 得分为 0.906。结论:我们的研究表明,该算法在检测窦性心律方面具有很高的有效性,在检测心房颤动方面也具有较低的有效性。这一结果表明,该算法可作为一种独立的工具发挥作用,尤其是在检测窦性心律方面。
{"title":"Can eHealth programs for cardiac arrhythmias be scaled-up by using the KardiaMobile algorithm?","authors":"Bridget M.I. Slaats Bsc ,&nbsp;Sebastiaan Blok PhD ,&nbsp;G. Aernout Somsen MD, PhD ,&nbsp;Igor I. Tulevski MD, PhD ,&nbsp;Reinoud E. Knops MD, PhD, FHRS ,&nbsp;Bert-Jan H. van den Born MD, PhD ,&nbsp;Michiel M. Winter MD, PhD","doi":"10.1016/j.cvdhj.2023.11.004","DOIUrl":"10.1016/j.cvdhj.2023.11.004","url":null,"abstract":"<div><h3>Background</h3><p>Remote monitoring devices for atrial fibrillation are known to positively contribute to the diagnostic process and therapy compliance. However, automatic algorithms within devices show varying sensitivity and specificity, so manual double-checking of electrocardiographic (ECG) recordings remains necessary.</p></div><div><h3>Objective</h3><p>The purpose of this study was to investigate the validity of the KardiaMobile algorithm within the Dutch telemonitoring program (HartWacht).</p></div><div><h3>Methods</h3><p>This retrospective study determined the diagnostic accuracy of the algorithm using assessments by a telemonitoring team as reference. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and F1 scores were determined.</p></div><div><h3>Results</h3><p>A total of 2298 patients (59.5% female; median age 57 ± 15 years) recorded 86,816 ECGs between April 2019 and January 2021. The algorithm showed sensitivity of 0.956, specificity 0.985, PPV 0.996, NPV 0.847, and F1 score 0.976 for the detection of sinus rhythm. A total of 29 false-positive outcomes remained uncorrected within the same patients. The algorithm showed sensitivity of 0.989, specificity 0.953, PPV 0.835, NPV 0.997, and F1 score 0.906 for detection of atrial fibrillation. A total of 2 false-negative outcomes remained uncorrected.</p></div><div><h3>Conclusion</h3><p>Our research showed high validity of the algorithm for the detection of both sinus rhythm and, to a lesser extent, atrial fibrillation. This finding suggests that the algorithm could function as a standalone instrument particularly for detection of sinus rhythm.</p></div>","PeriodicalId":72527,"journal":{"name":"Cardiovascular digital health journal","volume":"5 2","pages":"Pages 78-84"},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666693623000774/pdfft?md5=2c239dcb8183411753a06321db03891a&pid=1-s2.0-S2666693623000774-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135764518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Postoperative atrial fibrillation: Prediction of subsequent recurrences with clinical risk modeling and artificial intelligence electrocardiography 术后心房颤动:通过临床风险建模和人工智能心电图预测后续复发
Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-04-01 DOI: 10.1016/j.cvdhj.2024.02.004
Alanna M. Chamberlain PhD , Nicholas P. Bergeron MD , Abdullah K. Al-Abcha MD , Susan A. Weston MS , Ruoxiang Jiang BS , Zachi I. Attia PhD , Paul A. Friedman MD, FHRS , Bernard J. Gersh MB, ChB, DPhil, FHRS , Peter A. Noseworthy MD, MBA, FHRS , Konstantinos C. Siontis MD, FHRS
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引用次数: 0
期刊
Cardiovascular digital health journal
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