JMIR Cardio最新文献

{"title":"Influence of Perioperative Variables on Surgical Site Infection in Patients With Frailty and Prefrailty Undergoing Coronary Artery Bypass Grafting: Retrospective Multicenter Study.","authors":"Mauricio Guerrieri, Omar Mejia, Bianca Meneghini, Natali Rodrigues, William Burato, Maisa Barros, Daniel Wernsbach, Lucas Bartelega, Alexandre Hueb, Fabio Jatene","doi":"10.2196/79408","DOIUrl":"10.2196/79408","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection (SSI) in patients with frailty undergoing myocardial revascularization is a major clinical challenge, and there is a gap in the literature related to this topic.</p><p><strong>Objective: </strong>This study aimed to identify perioperative variables associated with SSI in patients with frailty and prefrailty undergoing coronary artery bypass grafting within 30 days of the procedure.</p><p><strong>Methods: </strong>This retrospective observational study included 467 patients with frailty or prefrailty aged 60 years and older who underwent coronary artery bypass grafting in 6 Brazilian centers between January 2018 and December 2024. Frailty was defined using the Fried criteria. SSI was defined as a wound with exposed tissue with positive culture requiring antibiotic treatment. Univariate and multivariate analyses were carried out.</p><p><strong>Results: </strong>The rate of SSI was 5.6% (26/467). The New York Heart Association classification (<i>P</i>=.02), Charlson Comorbidity Index (CCI; <i>P</i>=.01), use of cardiopulmonary bypass (CPB; <i>P</i>=.003), CPB time (<i>P</i>=.02), total surgery time (<i>P</i><.001), occurrence of bleeding (<i>P</i>=.04), mechanical ventilation time (<i>P</i>=.001), length of hospital stay (<i>P</i><.001), intensive care unit stay (<i>P</i><.001), and need for reoperation (<i>P</i><.001) variables were associated with SSI in unadjusted comparisons. In the multivariate model, the CCI (odds ratio 1.58, 95% CI 1.25-1.99; <i>P</i><.001) and use of CPB (odds ratio 4.89, 95% CI 1.71-13.94; <i>P</i>=.003) were independently associated with SSI.</p><p><strong>Conclusions: </strong>The CCI and the use of CPB were independently associated with SSI.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e79408"},"PeriodicalIF":2.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206758","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":"Human vs Artificial Intelligence in Detecting Coronary Occlusions in ST-Elevation Myocardial Infarction: Retrospective Study.","authors":"Aurelia Zimmerli, Marion Dupre, Quentin Liabot, C-Yasmine Sellah, David Meier, Adil Salihu, Victor Weerts, Vladimir Rubimbura, Olivier Roux, Olivier Muller, Olivier Hugli, Pierre-Nicolas Carron, Stephane Fournier","doi":"10.2196/88399","DOIUrl":"10.2196/88399","url":null,"abstract":"<p><strong>Background: </strong>Occlusion myocardial infarction (OMI) on the electrocardiogram (ECG) can present as ST-elevation myocardial infarction (STEMI), non-STEMI, ST depression, or other patterns (eg, de Winter T waves and hyperacute T waves), posing a diagnostic challenge. Even experienced physicians may overlook OMI on ECG, leading to delays in catheterization laboratory activation. Recently, smartphone apps using AI have been shown to exhibit promising accuracy in ECG interpretation in large datasets.</p><p><strong>Objective: </strong>The objective of our study was to retrospectively compare the diagnostic performance of an AI-based application (PMCardio) with that of interventional cardiologists in interpreting nonpathognomonic ECGs that generated debates about diagnosis.</p><p><strong>Methods: </strong>In total, 33 ECGs that were diagnostically challenging upon patient admission to the emergency department were included. A group of 3 interventional cardiologists, blinded to the final diagnosis, independently assessed whether the ECG suggested OMI requiring immediate invasive coronary angiography. The diagnostic performance of the cardiologists was compared to that of the AI application, using the results of coronary angiography as the gold standard and considering any lesion with ≥90% stenosis as positive.</p><p><strong>Results: </strong>Of the 33 patients, 29 (88%) had a final diagnosis of cardiac origin for their chest pain, including 23 acute coronary syndromes, of which 13 (57%) were OMI. The 3 cardiologists achieved sensitivities of 62%, 85%, and 62%; negative predictive values (NPVs) of 74%, 83%, and 69%; specificities of 70%, 50%, and 55%; and positive predictive values (PPVs) of 57%, 52%, and 47%. Their overall misclassification rates were 33%, 36%, and 42%. In contrast, AI analysis demonstrated a sensitivity and NPV of 100%, a specificity of 60%, a PPV of 62%, and an overall misclassification rate of 24%.</p><p><strong>Conclusions: </strong>In this retrospective study of challenging ECGs, an AI application demonstrated better diagnostic performance of OMI as compared to cardiologists. These findings highlight the potential of AI to enhance diagnostic accuracy and support clinical decision-making.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e88399"},"PeriodicalIF":2.4,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181997","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":"Real-Time Physical Activity Self-Monitoring in Patients Hospitalized for Cardiology Care: Interrupted Time Series Analysis.","authors":"Carlos de Miguel Llorente, Gertjan T J Sieswerda, Kaoutar Karramass, Charlotte Rommens, Thomas J Hoogeboom, Karin Valkenet","doi":"10.2196/92189","DOIUrl":"10.2196/92189","url":null,"abstract":"<p><strong>Background: </strong>Hospital admission is associated with increased sedentary behavior and low levels of physical activity. Hospitals have developed several strategies and interventions to address this unwanted inactivity and increase patient movement during admission. Self-monitoring of physical activity is a promising approach to support activity during hospital stays.</p><p><strong>Objective: </strong>This study investigated whether providing patients with real-time physical activity feedback, compared to a context where only health care practitioners had access to activity data, supported patients in maintaining activity levels in the cardiology ward.</p><p><strong>Methods: </strong>A Hybrid Type 2 interrupted time series design was applied. In phase 1 (24 wk), patients wore accelerometers (Physical Activity Monitor [PAM] AM400) with data visible only to health care professionals. In phase 2 (24 wk), self-monitoring was introduced using a ward-based screen that provided patients with real-time feedback on daily physical activity. Implementation outcomes were evaluated within the RE-AIM (Reach, Effectiveness, Adoption, and Implementation) framework, with \"Maintenance,\" defined as daily physical activity trends over time, serving as the primary outcome. The other RE-AIM dimensions were assessed as secondary outcomes.</p><p><strong>Results: </strong>A total of 159 patients were included (n=75 in phase 1 and n=84 in phase 2). Daily physical activity levels were expressed as active minutes per day. No significant immediate change in daily activity occurred at the start of phase 2 vs the end of phase 1 (β=-0.127, <i>P</i>=.81). In phase 1, physical activity declined statistically significantly over time (β=-0.002, <i>P</i><.001; ~6% decrease per month). In phase 2, following the introduction of the self-monitoring intervention, this decline was no longer observed, and activity levels were maintained. A significant phase interaction (β=0.002, <i>P</i>=.03) confirmed stabilization of physical activity levels in phase 2. Secondary RE-AIM outcomes did not differ between phases.</p><p><strong>Conclusions: </strong>The decline observed when only health care professionals accessed the data was no longer present once patients could monitor their own physical activity. Although seasonal influences cannot be excluded, these findings suggest that patient self-monitoring may support the maintenance of physical activity during hospital stays. Sustainability is complex, and determining the effect of patient self-monitoring alone remains challenging. Larger studies are needed to confirm these results.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e92189"},"PeriodicalIF":2.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127539","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":"Assessment of Wrist-Worn Activity Tracker Accuracy for Measuring Sedentary Behavior in Outpatients With Cardiovascular Disease: Validation Study.","authors":"Koichi Naito, Kazuhiro P Izawa, Noriaki Maeda, Yuya Kasai, Haruna Tani, Misaki Kondo, Hajime Iwama","doi":"10.2196/91104","DOIUrl":"https://doi.org/10.2196/91104","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Wearable monitoring of sedentary behavior is increasingly used in digital cardiovascular care, but the validity of consumer-grade wrist-worn trackers in older patients with cardiac issues is unclear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate the agreement between sedentary time measured by a consumer-grade wrist-worn tracker (Fitbit Inspire 3; Fitbit LLC) and a research-grade waist-worn accelerometer (ActiveStyle Pro HJA-750C; Omron Healthcare Co, Ltd) used as the comparator, in Japanese outpatients with cardiac issues under free-living conditions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Fifty-one outpatients with heart failure (28/51, 55%) or ischemic heart disease (23/51, 45%; mean age 78.4, SD 9.0 years; 25/51, 49% male) simultaneously wore both devices for 7 consecutive days. Sedentary time was assessed within a standardized 12-hour daytime window (9 AM to 9 PM) at 1-minute epochs. Agreement was examined using Pearson correlation, Bland-Altman analysis (after confirming normality of the paired differences), Lin concordance correlation coefficient (CCC), and Cohen kappa for distribution-based tertile classification. A constant bias correction was applied, with leave-one-out cross-validation (LOOCV) used as an internal-consistency check on the stability of the sample mean bias. Moderators of the bias were explored using multivariable regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean sedentary time within the 12-hour window was 497.9 (SD 86.5) minutes for the comparator and 559.9 (SD 84.3) minutes for the Fitbit. The devices were strongly correlated (&lt;i&gt;r&lt;/i&gt;=0.905, 95% CI 0.838-0.945; &lt;i&gt;P&lt;/i&gt;&lt;.001). The Fitbit showed a significant fixed bias of 62.0 minutes (95% CI 51.5-72.5; &lt;i&gt;P&lt;/i&gt;&lt;.001) with no proportional bias (slope -0.03; &lt;i&gt;P&lt;/i&gt;=.67); the 95% limits of agreement were wide (-11.3 to 135.2 minutes). Uncorrected concordance was moderate (CCC=0.71, 95% CI 0.57-0.80) and improved to high after subtracting the 62-minute bias (CCC=0.904, 95% CI 0.84-0.94); LOOCV indicated that this in-sample improvement was internally stable (out-of-sample CCC=0.90). No candidate factor (sex, age, diagnosis, and musculoskeletal disorder) significantly moderated the bias (model &lt;i&gt;P&lt;/i&gt;=.12). Tertile classification showed moderate agreement (κ=0.588, 95% CI 0.405-0.772; 37/51, 72.5% agreement), with all misclassifications between adjacent categories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In older Japanese outpatients with cardiac issues, a consumer-grade wrist-worn tracker overestimated sedentary time by approximately 62 minutes within a standardized 12-hour daytime window compared with a waist-worn comparator, with fixed but no proportional bias. A simple constant correction markedly improved group-level concordance (cross-validated CCC≈0.90), supporting calibrated use of consumer wearables for scalable monitoring in ambulatory cardiac care. However, wide limits of agreement constrain individual-level precision, and","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e91104"},"PeriodicalIF":2.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109595","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 Cardiometabolic Health in Adolescent Girls With Elevated Anxiety: Web-Based Multisite, Pilot, and Feasibility Randomized Controlled Trial.","authors":"Caitlin Edwards, Lisa Ranzenhofer, Jason Lavender, Lauren D Gulley, Stephen Aichele, Isabel Thorstad, Natalia Sanchez, Ruby Schrag, Zoe Sinkford, Jill Emerick, Victoria Thomas, Thomas Arnold, Jami Young, Denise Wilfley, Mark Haigney, Lauren Shomaker, Marian Tanofsky-Kraff","doi":"10.2196/82781","DOIUrl":"10.2196/82781","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anxiety is common in adolescents with elevated BMI (kg/m&lt;sup&gt;2&lt;/sup&gt;), affecting 33%-43% of adolescents with overweight or obesity (age- and sex-specific BMI ≥85th percentile ). Anxiety has been associated with poorer cardiometabolic health, and disinhibited eating in response to anxiety may be a key explanatory mechanism. Therefore, reducing anxiety in adolescents may improve disinhibited eating patterns and prevent worsening cardiometabolic health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This pilot study primarily aimed to assess the feasibility and acceptability of 2 virtual group psychological interventions, interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT), in adolescent girls with elevated anxiety and above-average weight. Secondary aims were to describe changes in anxiety, eating behavior, and cardiometabolic health indices.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This 2-site, 2-year, pilot and feasibility randomized controlled trial enrolled 12- to 17-year-old girls with elevated anxiety symptoms (State-Trait Anxiety Inventory for Children total score ≥32) and above-average weight (BMI ≥75th percentile for age and sex), who were in good general health and not concurrently receiving therapy or medication treatment. Girls were randomly assigned to 1 of 2 web-based arms: 12-week, psychologist-led, group IPT or CBT. In both arms, groups of 5-7 adolescents met for 90 minutes on secure Zoom (Zoom Communications, Inc) once per week. Anxiety, disinhibited eating, BMI indices, blood pressure, lipids, hemoglobin A&lt;sub&gt;1c&lt;/sub&gt; (HbA&lt;sub&gt;1c&lt;/sub&gt;), and fasting glucose were measured at baseline, 12-week follow-up, and 1-year follow-up. Feasibility of recruitment, retention, and study protocol, and acceptability and fidelity of IPT and CBT were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 47 eligible adolescents, 40 (85%) enrolled. Enrollment of the total sample (n=40) was completed in 7 months. Retention was 85% (n=17) in IPT and 100% (n=20) in CBT at 12-week follow-up. Protocol adherence exceeded 96% for all intervals. Missing data varied, with higher rates for phlebotomy (up to 30%). Acceptability ratings were above-average for likability (mean 3.03, SD 1.14) and credibility (mean 3.26, SD 0.75; 0-4 scale with 4=Highest) across arms. Most adolescents received ≥80% intervention dosage (IPT: 90%, CBT: 95%). Expert fidelity ratings of IPT were 78% (SD 11%) and CBT were 94% (SD 9%). From baseline to 1-year, IPT demonstrated improvements in general anxiety (95% CI -8.95 to -1.40), social anxiety (95% CI -12.37 to -1.88), and HbA&lt;sub&gt;1c&lt;/sub&gt; (95% CI -0.48 to -0.23); CBT demonstrated improvement in emotional eating (95% CI -1.18 to -0.18), and both arms demonstrated improvements in BMI percentile (effect sizes=-0.82 and -0.63, IPT and CBT, respectively).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This pilot and feasibility trial provided initial support for the feasibility of recruitment and retention and acceptability o","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e82781"},"PeriodicalIF":2.4,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13585365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989984","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":"Bidirectional Associations Between Autonomic Function, Sleep Quality, and Daily Fatigue and Energy Symptoms in Long COVID: Longitudinal Digital Health Study.","authors":"Nana Yaw Aboagye, Mark R Baker, Kenneth Baker, Silvia Del Din","doi":"10.2196/99630","DOIUrl":"10.2196/99630","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Long COVID is characterized by persistent fatigue, with disrupted autonomic function and sleep disturbances frequently reported. Whether daily symptom severity influences subsequent sleep and autonomic recovery (the reverse temporal direction) remains underexplored.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to examine bidirectional, within-person associations between objectively measured sleep quality, nocturnal heart rate variability (HRV), and daily fatigue and energy levels in individuals reporting post-COVID fatigue symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a longitudinal observational study using continuous wearable monitoring (Fitbit Inspire 3) in 14 individuals with long COVID over a median of 28 days (range 12-73 d), yielding 678,057 minute-level observations. Nocturnal HRV parameters (root mean square of successive differences [RMSSD], high-frequency power, low-frequency/high-frequency ratio) and sleep metrics (duration, efficiency, deep sleep, rapid eye movement [REM] sleep) were derived automatically. Fatigue (4-level scale) and energy (5-level scale, 0-100) were reported via smartphone app (FatigueSense). Two temporal linking strategies were applied: (1) prospective, linking morning/afternoon symptom reports to the previous night's sleep/HRV; and (2) reverse-direction, linking evening reports to the subsequent night's sleep/HRV. Repeated-measures correlation (rmcorr) accounted for within-person clustering; person-mean-centered (Mundlak) cumulative link mixed models disaggregated within-person from between-person effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Prospective within-person rmcorr analyses (n=260 observations, 14 participants) identified 3 associations surviving Bonferroni correction (α=.0031): sleep duration (&lt;i&gt;r&lt;/i&gt;=-0.276, 95% CI -0.392 to -0.152; &lt;i&gt;P&lt;/i&gt;&lt;.001) and REM sleep (&lt;i&gt;r&lt;/i&gt;=-0.215, 95% CI -0.342 to -0.079; &lt;i&gt;P&lt;/i&gt;=.002) with next-day fatigue, and sleep efficiency with next-day energy in the counterintuitive negative direction (&lt;i&gt;r&lt;/i&gt;=-0.196, 95% CI -0.317 to -0.068; &lt;i&gt;P&lt;/i&gt;=.003). HRV metrics showed no significant within-person day-to-day associations with symptoms (HRV-RMSSD → fatigue: &lt;i&gt;r&lt;/i&gt;=-0.064, &lt;i&gt;P&lt;/i&gt;=.36). Mundlak models revealed that HRV-RMSSD associations were predominantly between-person: individuals with chronically higher HRV reported consistently lower fatigue (β=-1.260, 95% CI -2.231 to -0.290; &lt;i&gt;P&lt;/i&gt;=.01) and higher energy (β=0.539, 95% CI 0.056 to 1.022; &lt;i&gt;P&lt;/i&gt;=.03). A significant Sleep × Steps interaction (β=0.091 per SD of steps per 1000; &lt;i&gt;P&lt;/i&gt;=.02) indicated that the protective association of longer sleep on fatigue was attenuated on more active days, consistent with a postexertional malaise pattern. In an exploratory reverse-direction analysis, evening energy (but not fatigue) showed an association with that night's HRV-RMSSD that was nominally significant but did not persist after Bonferroni correction (rmcorr: &lt;i&gt;r&lt;/i&gt;=0.327","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e99630"},"PeriodicalIF":2.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968644","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":"Digital Health Use and Interest in Virtual Cardiac Rehabilitation Among Cardiac Inpatients: Cross-Sectional Study.","authors":"Hamza G Patel, Jie Ding, Xinyi Zhang, Abel Cherian, Pauline Hyunh, Apurva Sharma, Vennela Avula, Rongzi Shan, Katherine A Ornstein, Shireen R Khoury, Francoise A Marvel, Lena M Mathews, Seth S Martin, Erin M Spaulding","doi":"10.2196/91767","DOIUrl":"10.2196/91767","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) improves patient quality of life, morbidity, and mortality. Unfortunately, it is underused by patients. Digital health interventions offer a solution to increase participation in CR. However, patients' interest in virtual CR, especially among those in the inpatient setting, has not been fully explored. The benefits of CR have been predominantly demonstrated in traditional, center-based CR programs.</p><p><strong>Objective: </strong>The objective of this cross-sectional study with prospective enrollment was to explore inpatient interest in virtual CR among adult patients who were hospitalized with a CR-qualifying diagnosis.</p><p><strong>Methods: </strong>A Qualtrics survey comprising multiple-choice questions was administered to cardiac inpatients at the progressive cardiac care unit at the Johns Hopkins Hospital from January 2020 to March 2024. Sociodemographic and clinical characteristics were retrieved from the electronic medical records. The study included English-speaking patients aged 18 years or older with a diagnosis eligible for CR. Digital health use was compared between an earlier enrollment period (2020-2022) and a later enrollment period (2023-2024).</p><p><strong>Results: </strong>A total of 150 patients were included (mean age 64, SD 13 years; n=57, 38% female, and n=85, 56.7% White). With respect to sociodemographic characteristics, 26% (n=39) of the patients had a high school education or less, 53.8% (70/130) were married, 26.2% (34/130) were employed full time, and 63.8% (83/130) had private insurance. In exploratory enrollment-period comparisons, texting health care providers was more commonly reported in 2023 to 2024 than in 2020 to 2022 (74/123, 60.2% vs 6/27, 22.2%; <i>P</i><.001), as was using a smartphone or tablet to learn about illnesses (93/123, 75.6% vs 17/27, 63%; <i>P</i>=.04) and to discuss health with a physician or nurse practitioner (86/123, 69.9% vs 12/27, 44.4%; <i>P</i>=.01). Participants with more than a high school education were more likely to perceive smartphones as beneficial for leading a healthier lifestyle (50/104, 48.1% vs 9/37, 24.3%, <i>P</i>=.01) and learning about illnesses (90/105, 85.7% vs 20/37, 54.1%, <i>P</i><.001) than were participants with a high school education or less. Participants across all sociodemographic factors expressed interest in virtual CR (overall 107/150, 71.3%), with non-White participants being more interested than White participants (55/65, 84.6% vs 52/85, 61.2%, <i>P</i>=.002).</p><p><strong>Conclusions: </strong>Most cardiac inpatients expressed interest in home-based or virtual CR to alleviate barriers to in-person CR participation. Future work should emphasize digital equity and user support to optimize the widespread adoption of virtual CR.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e91767"},"PeriodicalIF":2.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13566072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945145","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":"Feasibility of Mobile Single-Lead Electrocardiogram Screening for Atrial Fibrillation: Multicenter Cross-Sectional Study.","authors":"Robert Fenske, Denise Rossa, Christian Butter, Felix Muehlensiepen, Jonathan Nübel, Daniel Meretz, Oliver Ritter, Sebastian Spethmann, Rene Mantke, Mario Zerbaum, Nico Draheim, Nicole Lindenberg-Krause, Anja Haase-Fielitz","doi":"10.2196/92799","DOIUrl":"10.2196/92799","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a major contributor of thromboembolic stroke. However, early detection remains challenging and is severely hindered by structural limitations in health care infrastructure. While current clinical guidelines recognize a 30-second single-lead electrocardiogram (ECG) as a standard diagnostic tool, the actual deployment and real-world utility of mobile screening technologies across health care settings remain poorly understood.</p><p><strong>Objective: </strong>The primary objective of this study was to evaluate the real-world feasibility of a mobile single-lead ECG for the detection of AF in routine inpatient and outpatient settings. Feasibility was evaluated by the proportion of successfully completed recordings, patient acceptance, and the occurrence and characteristics of technical challenges during deployment.</p><p><strong>Methods: </strong>This multicenter, cross-sectional pragmatic implementation study enrolled patients across 3 university hospitals and 3 primary care practices. Screening was performed using an US Food and Drug Administration (FDA)-approved single-lead ECG device (AliveCor KardiaMobile). Patients with an automated device reading indicating \"Possible AF\" and no prior diagnosis of AF underwent a confirmatory 12-lead ECG. Patient awareness and acceptance were evaluated using an exploratory, descriptive questionnaire.</p><p><strong>Results: </strong>A total of 237 patients were enrolled (194 inpatients and 43 outpatients). The device algorithm provided an automatic interpretation in 95.3% (41/43) of the outpatients and 85.6% (166/194) of inpatients, resulting in an overall automated detection of AF in 21.5% (51/237) of the cohort. The algorithm identified newly suspected AF in 1.7% (4/237) of patients without a prior AF diagnosis. Of these, 1 case underwent same-day confirmatory 12-lead ECG and was confirmed as AF. Technical challenges occurred in 16.0% (38/237) of all recordings, with a numerical higher rate observed in the inpatient setting (34/194, 17.5% vs 4/43, 9.3% in outpatients; <i>P</i>=.25). Only 6.3% (15/237) of patients reported regular use of telemedicine applications.</p><p><strong>Conclusions: </strong>Mobile single-lead ECG screening is feasible in routine inpatient and outpatient settings and identified a substantial prevalence of AF, which increased with age. The high detection rate underscores the potential of wearable ECG devices to facilitate early detection of AF. However, the absence of systematic confirmatory ECG testing and limited patient engagement with telemedicine applications highlight challenges in real-world implementation.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e92799"},"PeriodicalIF":2.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930072","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":"Group-Based Multitrajectory Modeling Analysis of Joint Trajectories of Blood Pressure and Heart Rate and Their Association With Relative Change in Relative Wall Thickness in Patients With Hypertension: Community-Based Longitudinal Cohort Study.","authors":"Qi Pan, Nanxiang Zhang, Shuo Yang, Chonglong Ding, Jianan Yin, Yi Fei, Xinyan Zou, Yongjun Zheng, Xiang Huang, Jiezhen Feng, Hai Lin, Jinxin Zhang","doi":"10.2196/87091","DOIUrl":"10.2196/87091","url":null,"abstract":"<p><strong>Background: </strong>Ambulatory blood pressure monitoring objectively assesses circadian hemodynamic rhythms. However, the joint trajectories of longitudinal blood pressure (BP) and heart rate (HR), and their association with early hypertensive cardiac remodeling, remain incompletely characterized.</p><p><strong>Objective: </strong>This study aimed to identify joint trajectories of BP and HR using group-based multitrajectory modeling and examine their associations with relative changes in relative wall thickness (<i>Δ</i>RWT).</p><p><strong>Methods: </strong>This community-based longitudinal cohort study included 213 patients with hypertension, with data collected between November 2022 and January 2025. Participants underwent 4 ambulatory BP monitoring sessions over 6 months, and echocardiography was measured at 3 months and 9 months. Group-based multitrajectory modeling was used to identify joint trajectories of 24-hour mean systolic blood pressure, diastolic blood pressure, and HR. A full-model multiple linear regression estimated the associations between trajectory groups and <i>Δ</i>RWT. Sensitivity analyses were conducted by adjusting for age and sex, and by using complete-case data.</p><p><strong>Results: </strong>Four joint trajectory groups were identified: group 1 (lowest BP and HR, n=59), group 2 (normal BP, high HR, n=60), group 3 (stage 1 hypertension range, normal HR, n=54), and group 4 (stage 2 hypertension range, high HR, n=40). In the primary adjusted multiple linear regression model, compared with group 4, group 2 showed a significant inverse association with changes in <i>Δ</i>RWT (<i>b</i>=-0.059, 95% CI -0.112 to -0.007; <i>P</i>=.03). Antidiabetic medication use was significantly associated with a reduction in <i>Δ</i>RWT (<i>b</i>=-0.067, 95% CI -0.116 to -0.018; <i>P</i>=.008). Waking up before 7 AM was positively associated with an increase in <i>Δ</i>RWT (<i>b</i>=0.045, 95% CI 0.007-0.083; <i>P</i>=.02). Notably, the association for group 2 attenuated to marginal significance (<i>P</i>=.06) in the complete-case analysis, primarily due to the reduction in statistical power.</p><p><strong>Conclusions: </strong>Hypertensive cardiac remodeling exhibits significant heterogeneity across distinct joint systolic blood pressure, diastolic blood pressure, and HR trajectories. Stable BP control is associated with a potential attenuation of early cardiac remodeling even in the presence of an elevated HR; however, this beneficial association attenuated to marginal significance in the complete-case analysis. Concurrent antidiabetic medication use and waking after 7 AM showed a beneficial association with the relative change in <i>Δ</i>RWT.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e87091"},"PeriodicalIF":2.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919953","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":"Co-Creation and Usability Testing of a Digital Cardiac Rehabilitation Program (eCardiacRehab): Design and Development Study.","authors":"Oda Karin Nordfonn, Kristin Johnsen Ramstad, Trond Roed Pettersen, Nina Hjertvikrem, Inger-Lise Aamot Aksetøy, Alf Johannes Agcaoili Borge, Eva Gerdts, Jan Gunnar Hesthammer, Torstein Hole, Irene Instenes, Anita Isaksen, Ole Andreas Krumsvik, Merethe Landaas, Christian Moltu, Svein Rotevatn, Jan Schjøtt, Cathrine Horn Sommersten, Jan Ove Tryti, Tone Merete Norekvål","doi":"10.2196/93398","DOIUrl":"10.2196/93398","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiac rehabilitation (CR) is a class IA-recommended treatment and secondary preventive strategy for people with coronary artery disease. eHealth solutions show promise in providing accessible CR. However, few provide a comprehensive and multimodal CR program, and most programs are developed without input from end users.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to provide a detailed description of the multidisciplinary co-creation process used to develop a person-centered, multimodal digital CR program that integrated the perspectives of stakeholders and end users throughout, with the rationale to optimize the acceptance and feasibility of the CR program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We incorporated a user-centered design with a 3-phase, iterative, multidisciplinary stakeholder co-creation process. This included &lt;i&gt;defining needs&lt;/i&gt; (phase 1), &lt;i&gt;development and refinement&lt;/i&gt; (phase 2), and &lt;i&gt;testing and optimization&lt;/i&gt; (phase 3). Overall, 26 internal stakeholders from the project team participated, including clinicians, researchers, software developers, and user representatives. In addition, 35 external stakeholders (20 clinicians and 15 people with cardiac-related problems) participated in a user-centered development process that included workshops, intervention content development, and usability testing. Data were collected through contextual inquiry, 4 workshops with stakeholders, 12 co-creation sessions with user representatives, 2 usability testing sessions using a think-aloud methodology, standardized usability surveys, and individual and focus group interviews. Intervention content was developed and finalized based on existing evidence, stakeholder input, and user testing. A smoke test and a minimum viable product test were conducted. Data were analyzed using rapid qualitative content analysis and descriptive statistics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Analyses of data gathered across the 3 phases identified 5 themes important to stakeholders and end users: a program with (1) personalized and tailored solutions with reliable, trustworthy, and evidence-based content (ie, a face-to-face introduction session at the start of the program and a tailored registration page to individually register personal risk factors, goals, and medications); (2) options for feedback (ie, an asynchronous messaging service and tailored face-to-face video consultations with clinicians); (3) peer support (ie, exercise sessions in groups); (4) digital reminders (ie, notifications on a smartphone or tablet); and (5) motivational features (ie, interactive cardiac-specific learning modules on coronary artery disease and secondary prevention). Evidence-based content development resulted in 9 cardiac-specific interactive learning modules, a module for personal health data entry, live exercise sessions, tailored digital follow-up, and an asynchronous messaging service. Readability was assessed using the Gunning F","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e93398"},"PeriodicalIF":2.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13533320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874030","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}