JMIR Cardio最新文献

{"title":"Evaluation of a Virtual Home Health Heart Failure Program: Mixed Methods Study.","authors":"Nilufeur McKay, Rosemary Saunders, Helene Metcalfe, Sue Robinson, Peter Palamara, Kellie Steer, Jeannie Yoo, Miles Ranogajec, Lisa Whitehead, Beverley Ewens","doi":"10.2196/64877","DOIUrl":"10.2196/64877","url":null,"abstract":"<p><strong>Background: </strong>Heart failure is a prevalent and debilitating condition, affecting millions globally and imposing a significant burden on patients, families, and health care systems. Despite advancements in medical treatments, the gap in effective, continuous, and personalized supportive care remains glaringly evident. To address this pressing issue, virtual health care services delivered by interdisciplinary teams represent a promising solution. Understanding the outcomes and experience of remote monitoring-enabled interdisciplinary chronic disease management programs can inform resource allocation and health care policy decisions.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate the clinical and behavioral outcomes of patients undertaking a Virtual Home Health Heart Failure Program (VHHHFP) and explore the experiences of patients and health care practitioners (HCPs).</p><p><strong>Methods: </strong>The VHHHFP is a virtual postdischarge support service for patients with heart failure that includes an intensive 3-month period followed by a maintenance period delivered by an interdisciplinary team. A mixed methods study was conducted with patients and HCPs. Self-reported outcome data (KCCQ-12 [Kansas City Cardiomyopathy Questionnaire-12], PHQ-4 [Patient Health Questionnaire-4], PAM-13 [Patient Activation Measure-13], and PREMs [Patient Reported Experience Measures]) were obtained from the records of patients (N=49) who completed the intensive phase of the VHHHFP, and interviews were conducted with patients (n=9) and HCPs (n=6). A paired t test was used to compare quantitative data before and after the 3-month intervention, and a thematic qualitative analysis was undertaken of interview data.</p><p><strong>Results: </strong>Thirty-one of the 55 (77.5%) patients completed the baseline and 3-month follow-up KCCQ-12 assessment. The mean KCCQ-12 summary score at 3 months was 72.20 (SD 20.2), which was significantly higher than the mean summary score at baseline of 50.51 (SD 17.59; P<.001). These findings were similar for the KCCCQ-12 subscales: physical limitations (mean 47.09, SD 29.7 and mean 69.43, SD 22.6; P<.001), quality of life (mean 43.75, SD 21.7 and mean 62.91, SD 25.7; P<.001), symptom frequency (median 60.40, IQR 1-100 and median 91.70, IQR 35.40; P<.001), and social limitation (median 50.0, IQR 1-100 and median 82.50, IQR 32.50; P<.001). The PHQ-4 measure of psychological health was completed by 32 (80%) patients. The median scores at baseline and follow-up for total distress (median 1.50, IQR 0-7 and median 0.0, IQR 0-8; P<.02), and the anxiety subscale (median 1.0, IQR 0-6 and median 0.0, IQR 0-4; P<.02) reduced over time. Six hospital admissions were recorded (10.2% of 49 patients) within 30 days. Nine patient interviews aligned with the value-based health care (VBHC) Capability, Comfort, and Calm (CCC) framework. Three themes were identified, which are as follows: (1) enhanced patient capabili","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e64877"},"PeriodicalIF":2.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12309783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144698591","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}

{"title":"Barriers and Enablers to Routine Clinical Implementation of Cardiac Implantable Electronic Device Remote Monitoring in Australia Among Cardiologists, Cardiac Physiologists, Nurses, and Patients: Interview Study.","authors":"Brodie Sheahen, Edel T O'Hagan, Kenneth Cho, Tim Shaw, Astin Lee, Sean Lal, Aaron L Sverdlov, Clara Chow","doi":"10.2196/67758","DOIUrl":"10.2196/67758","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.\"</p><p><strong>Conclusions: </strong>Patient engagement was identified in 3 of the 5 themes describing barriers and enablers to RM. Th","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e67758"},"PeriodicalIF":2.2,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663829","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}

{"title":"Toward Ambulatory Baroreflex Sensitivity: Comparison Between Indices of Arterial Line and Photoplethysmography in Male Volunteers.","authors":"Jolanda Witteveen, Fabian Beutel, Evelien Hermeling","doi":"10.2196/54771","DOIUrl":"10.2196/54771","url":null,"abstract":"<p><strong>Background: </strong>Baroreflex sensitivity (BRS) is the body's ability to adjust heart rate (HR) to control blood pressure. Traditionally, BRS is quantified by measuring HR changes (obtained via an electrocardiogram [ECG]) following alterations in arterial pressure (conventionally measured through an arterial line). However, the invasiveness of arterial line necessitates alternatives, such as the volume clamp method and the less invasive pulse photoplethysmography (PPG). Notably, the PPG method is also suitable for continuous and free-living conditions.</p><p><strong>Objective: </strong>This study aims to compare PPG-based features for BRS determination based on the volume clamp method and gold standard arterial line. Data from a previous study was used where the primary analysis focused on evaluating the accuracy of PPG-derived HR variability, while this analysis quantifies BRS by measuring HR changes following alterations in arterial line pressure or less invasive alternatives. In addition, we investigate the feasibility of assessing BRS patterns over 24 hours using data from a single volunteer.</p><p><strong>Methods: </strong>A total of 28 male volunteers (age 52, SD 7 y; BMI 27, SD 4 kg/m2) equipped with four sensing modalities: (1) arterial line [ABP], (2) infrared PPG, (3) volume clamp finger pressure (VCP), and (4) ECG, performed a protocol of 3 repetitive sessions in supine position. For the extended feasibility of continuous BRS measurement, ECG and PPG data were acquired for 24 hours in free-living conditions from a normotensive male volunteer (33 y). BRS index was calculated within the low-frequency window (0.04-0.15 Hz) averaging over all trials for each intervention and participant. A transfer function was estimated with systolic blood pressure (SBP) or its surrogate as input and HR (from the ECG) as output.</p><p><strong>Results: </strong>PPG-based BRS features, specifically the rise-decay time ratio (RDRatio) and pulse arrival time (PAT), demonstrate intraparticipant precision of 44% and 23%, respectively, with interparticipant variation of 91% and 53%. The correlation of BRSPAT,PPG and BRSRDRatio,PPG with the gold standard BRSSBP,ABP (SBP) is 0.66 and 0.56, respectively. During intervention, the correlations remain high for BRSRDRatio,PPG (rest: 0.75, paced-breathing: 0.50, and handgrip: 0.46) and BRSPAT,PPG (rest: 0.69, paced-breathing: 0.52, and handgrip: 0.62). In the 24-hour data, the BRSPAT,PPG and BRSRDRatio,PPG exhibit changes during the day corresponding to the activity levels and SBP variations. Notably, during the night, a cyclic rhythm is observed for both BRSPAT,PPG and BRSRDRatio,PPG.</p><p><strong>Conclusions: </strong>This study demonstrates that in male volunteers, PPG-based PAT and RDRatio BRS serve as suitable surrogates for gold-standard BRS derived from arterial line, showing the highest correlation and comparable intraparticipant coefficient variation. Furthermore, they show expected changes during","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e54771"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12289223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144659264","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}

{"title":"Improving the Readability of Institutional Heart Failure-Related Patient Education Materials Using GPT-4: Observational Study.","authors":"Ryan C King, Jamil S Samaan, Joseph Haquang, Vishnu Bharani, Samuel Margolis, Nitin Srinivasan, Yuxin Peng, Yee Hui Yeo, Roxana Ghashghaei","doi":"10.2196/68817","DOIUrl":"10.2196/68817","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e68817"},"PeriodicalIF":2.2,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591279","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}

{"title":"Health Care Professionals' Use of Digital Technology in the Secondary Prevention of Cardiovascular Disease in Austria: Online Survey Study.","authors":"Luisa Lunz, Sabine Würth, Stefan Tino Kulnik","doi":"10.2196/71366","DOIUrl":"10.2196/71366","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e71366"},"PeriodicalIF":2.2,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12221187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144496717","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}

{"title":"Gender Differences in X (Formerly Twitter) Use, Influence, and Engagement Among Cardiologists From the Top U.S. News Best Hospitals.","authors":"Minji Seok, Sungjin Kim, Harper Tzou, Olivia Peony, Mitchell Kamrava, Andriana P Nikolova, Katelyn M Atkins","doi":"10.2196/66308","DOIUrl":"10.2196/66308","url":null,"abstract":"","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e66308"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12157951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225520","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}

{"title":"Machine Learning Model for Predicting Coronary Heart Disease Risk: Development and Validation Using Insights From a Japanese Population-Based Study.","authors":"Thien Vu, Yoshihiro Kokubo, Mai Inoue, Masaki Yamamoto, Attayeb Mohsen, Agustin Martin-Morales, Research Dawadi, Takao Inoue, Jie Ting Tay, Mari Yoshizaki, Naoki Watanabe, Yuki Kuriya, Chisa Matsumoto, Ahmed Arafa, Yoko M Nakao, Yuka Kato, Masayuki Teramoto, Michihiro Araki","doi":"10.2196/68066","DOIUrl":"10.2196/68066","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Coronary heart disease (CHD) is a major cause of morbidity and mortality worldwide. Identifying key risk factors is essential for effective risk assessment and prevention. A data-driven approach using machine learning (ML) offers advanced techniques to analyze complex, nonlinear, and high-dimensional datasets, uncovering novel predictors of CHD that go beyond the limitations of traditional models, which rely on predefined variables.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to evaluate the contribution of various risk factors to CHD, focusing on both established and novel markers using ML techniques.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The study recruited 7672 participants aged 30-84 years from Suita City, Japan, between 1989 and 1999. Over an average of 15 years, participants were monitored for cardiovascular events. A total of 7260 participants and 28 variables were included in the analysis after excluding individuals with missing outcome data and eliminating unnecessary variables. Five ML models-logistic regression, random forest (RF), support vector machine, Extreme Gradient Boosting, and Light Gradient-Boosting Machine-were applied for predicting CHD incidence. Model performance was evaluated using accuracy, sensitivity, specificity, precision, area under the curve, F1-score, calibration curves, observed-to-expected ratios, and decision curve analysis. Additionally, Shapley Additive Explanations (SHAPs) were used to interpret the prediction models and understand the contribution of various risk factors to CHD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 7260 participants, 305 (4.2%) were diagnosed with CHD. The RF model demonstrated the highest performance, with an accuracy of 0.73 (95% CI 0.64-0.80), sensitivity of 0.74 (95% CI 0.62-0.84), specificity of 0.72 (95% CI 0.61-0.83), and an area under the curve of 0.73 (95% CI 0.65-0.80). RF also showed excellent calibration, with predicted probabilities closely aligning with observed outcomes, and provided substantial net benefit across a range of risk thresholds, as demonstrated by decision curve analysis. SHAP analysis elucidated key predictors of CHD, including the intima-media thickness (IMT_cMax) of the common carotid artery, blood pressure, lipid profiles (non-high-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), and estimated glomerular filtration rate. Novel risk factors identified as significant contributors to CHD risk included lower calcium levels, elevated white blood cell counts, and body fat percentage. Furthermore, a protective effect was observed in women, suggesting the potential necessity for gender-specific risk assessment strategies in future cardiovascular health evaluations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We developed a model to predict CHD using ML and applied SHAP methods for interpretation. This approach highlights the multifactor nature of CHD risk evaluation, aiming to support health care pro","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e68066"},"PeriodicalIF":2.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063109","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}

{"title":"Correction: Results of a Digital Multimodal Motivational and Educational Program as Follow-Up Care for Former Cardiac Rehabilitation Patients: Randomized Controlled Trial.","authors":"Maxi Pia Bretschneider, Wolfgang Mayer-Berger, Jens Weine, Lena Roth, Peter E H Schwarz, Franz Petermann","doi":"10.2196/73890","DOIUrl":"10.2196/73890","url":null,"abstract":"","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e73890"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988812","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}

{"title":"Augmenting Engagement in Decentralized Clinical Trials for Atrial Fibrillation: Development and Implementation of a Programmatic Architecture.","authors":"Toluwa Daniel Omole, Andrew Mrkva, Danielle Ferry, Erin Shepherd, Jessica Caratelli, Noah Davis, Richmond Akatue, Timothy Bickmore, Michael K Paasche-Orlow, Jared W Magnani","doi":"10.2196/66436","DOIUrl":"10.2196/66436","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Atrial fibrillation (AF) is a chronic cardiovascular condition that requires long-term adherence to medications and self-monitoring. Clinical trials for AF have had limited diversity by sex, race and ethnicity, and rural residence, thereby compromising the integrity and generalizability of trial findings. Digital technology coupled with remote strategies has the potential to increase recruitment of individuals from underrepresented demographic and geographic populations, resulting in increased trial diversity, and improvement in the generalizability of interventions for complex diseases such as AF.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to summarize the architecture of a research program using remote methods to enhance geographic and demographic diversity in mobile health trials to improve medication adherence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We developed a programmatic architecture to conduct remote recruitment and assessments of individuals with AF in 2 complementary randomized clinical trials, funded by the National Institutes of Health, to test the effectiveness of a smartphone-based relational agent on adherence to oral anticoagulation. The study team engaged individuals with either rural or metropolitan residences receiving care for AF at health care settings who then provided consent, and underwent baseline assessments and randomization during a remotely conducted telephone visit. Participants were randomized to receive the relational agent intervention or control and subsequently received a study smartphone with installed apps by mail. Participants received a telephone-based training session on device and app usage accompanied by a booklet with pictures and instructions accessible for any level of health or digital literacy. The program included remote methods by mail and telephone to promote retention at 4-, 8-, and 12-month visits and incentivized return of the smartphone following study participation. The program demonstrated excellent participant engagement and retention throughout the duration of the clinical trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The trials enrolled 513 participants, surpassing recruitment goals for the rural (n=270; target n=264) and metropolitan (n=243; target n=240) studies. A total of 62% (319/513) were women; 31% (75/243) of participants in the metropolitan study were African American, Asian, American Indian or Alaskan native or other races or ethnicities, in contrast to 5% (12/270) in the rural study. Among all participants, 56% (286/513) had less than an associate's degree and 44% (225/513) were characterized as having limited health literacy. Intervention recipients receiving the relational agent used the agent median of 95-98 (IQR, 56-109) days across both studies. Retention exceeded 89% (457/513) at 12 months with study phones used for median 3.3 (IQR, 1-5) participants.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;We report here the development and implementation of a p","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e66436"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015819","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}

{"title":"Prerequisites for Cost-Effective Home Blood Pressure Telemonitoring: Early Health Economic Analysis.","authors":"Job van Steenkiste, Pim van Dorst, Daan Dohmen, Cornelis Boersma","doi":"10.2196/64386","DOIUrl":"10.2196/64386","url":null,"abstract":"<p><strong>Background: </strong>Home blood pressure telemonitoring (HBPT) has been proposed to enhance adherence and optimize health care delivery, yet its prerequisites for cost-effective implementation remain unclear.</p><p><strong>Objective: </strong>This study aims to quantify the potential cost-effectiveness of HBPT and identify prerequisites for cost-effective implementation of HBPT in comparison to standard hypertension management, using an early health economic analysis from a societal perspective.</p><p><strong>Methods: </strong>A decision-analytic Markov model with a lifetime horizon (30 years) and a willingness-to-pay threshold of €20,000 (€1=US $1.09) per quality-adjusted life year (QALY) was developed to assess the cost-effectiveness of HBPT compared to standard of care (SOC). The HBPT intervention was based on an existing HBPT program applied by the Maasstad Hospital, Rotterdam, the Netherlands. The model incorporated 12 health states: 7 blood pressure states, 1 cardiovascular (CV) event, 1 recurrent CV event, 1 postrecurrent CV event, 1 all-cause death, and 1 CV disease-related death. A hypothetical cohort of 1000 patients (average age 65.3 years) was modeled, and results were reported in costs, QALYs, and the incremental cost-effectiveness ratio (ICER). The model assumed 3 in-person outpatient department (OPD) consultations in the SOC group and 1.5 in the HBPT group. Extensive sensitivity analyses were performed to identify important variables for the cost-effective implementation of HBPT.</p><p><strong>Results: </strong>Following the base-case analysis, HBPT was not cost-effective with an ICER of €20,386 per QALY. Sensitivity analyses indicated that reducing the number of in-person OPD consultations resulted in a more favorable ICER. Specifically, reducing the number of in-person OPD consultations to 1.48 annually resulted in an ICER below the willingness-to-pay threshold. Reducing the in-person OPD consultations to an average of 1.18 per year would make HBPT cost-saving. Scenario analyses revealed that extending the duration of HBPT's clinical effect to 2 or 3 years substantially improved the ICER. Additionally, targeting HBPT toward patients aged 64 years or below further improved the ICER.</p><p><strong>Conclusions: </strong>HBPT could result in cost-effective or cost-saving outcomes with only minor reductions in in-person OPD consultations. These findings highlight the potential of HBPT to transform hypertension management by replacing traditional hypertension management with more efficient care using remote patient monitoring.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"9 ","pages":"e64386"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018233","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}