JMIR Cardio最新文献

{"title":"Comparison of Auscultation Quality Using Contemporary Digital Stethoscopes.","authors":"Norah Saraya, Jonathon McBride, Karandeep Singh, Omar Sohail, Porag Jeet Das","doi":"10.2196/54746","DOIUrl":"https://doi.org/10.2196/54746","url":null,"abstract":"","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"8 ","pages":"e54746"},"PeriodicalIF":0.0,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Development of Heart Failure Electronic-Message Driven Tips to Support Self-Management: Co-Design Case Study.","authors":"Caleb Ferguson, Scott William, Sabine M Allida, Jordan Fulcher, Alicia J Jenkins, Jo-Dee Lattimore, L-J Loch, Anthony Keech","doi":"10.2196/57328","DOIUrl":"10.2196/57328","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a complex syndrome associated with high morbidity and mortality and increased health care use. Patient education is key to improving health outcomes, achieved by promoting self-management to optimize medical management. Newer digital tools like SMS text messaging and smartphone apps provide novel patient education approaches.</p><p><strong>Objective: </strong>This study aimed to partner with clinicians and people with lived experience of HF to identify the priority educational topic areas to inform the development and delivery of a bank of electronic-message driven tips (e-TIPS) to support HF self-management.</p><p><strong>Methods: </strong>We conducted 3 focus groups with cardiovascular clinicians, people with lived experience of HF, and their caregivers, which consisted of 2 stages: stage 1 (an exploratory qualitative study to identify the unmet educational needs of people living with HF; previously reported) and stage 2 (a co-design feedback session to identify educational topic areas and inform the delivery of e-TIPS). This paper reports the findings of the co-design feedback session.</p><p><strong>Results: </strong>We identified 5 key considerations in delivering e-TIPS and 5 relevant HF educational topics for their content. Key considerations in e-TIP delivery included (1) timing of the e-TIPS; (2) clear and concise e-TIPS; (3) embedding a feedback mechanism; (4) distinguishing actionable and nonactionable e-TIPS; and (5) frequency of e-TIP delivery. Relevant educational topic areas included the following: (1) cardiovascular risk reduction, (2) self-management, (3) food and nutrition, (4) sleep hygiene, and (5) mental health.</p><p><strong>Conclusions: </strong>The findings from this co-design case study have provided a foundation for developing a bank of e-TIPS. These will now be evaluated for usability in the BANDAIDS e-TIPS, a single-group, quasi-experimental study of a 24-week e-TIP program (personalized educational messages) delivered via SMS text messaging (ACTRN12623000644662).</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"8 ","pages":"e57328"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11563649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604525","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":"Identifying the Severity of Heart Valve Stenosis and Regurgitation Among a Diverse Population Within an Integrated Health Care System: Natural Language Processing Approach.","authors":"Fagen Xie, Ming-Sum Lee, Salam Allahwerdy, Darios Getahun, Benjamin Wessler, Wansu Chen","doi":"10.2196/60503","DOIUrl":"10.2196/60503","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Valvular heart disease (VHD) is a leading cause of cardiovascular morbidity and mortality that poses a substantial health care and economic burden on health care systems. Administrative diagnostic codes for ascertaining VHD diagnosis are incomplete.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to develop a natural language processing (NLP) algorithm to identify patients with aortic, mitral, tricuspid, and pulmonic valve stenosis and regurgitation from transthoracic echocardiography (TTE) reports within a large integrated health care system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used reports from echocardiograms performed in the Kaiser Permanente Southern California (KPSC) health care system between January 1, 2011, and December 31, 2022. Related terms/phrases of aortic, mitral, tricuspid, and pulmonic stenosis and regurgitation and their severities were compiled from the literature and enriched with input from clinicians. An NLP algorithm was iteratively developed and fine-trained via multiple rounds of chart review, followed by adjudication. The developed algorithm was applied to 200 annotated echocardiography reports to assess its performance and then the study echocardiography reports.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 1,225,270 TTE reports were extracted from KPSC electronic health records during the study period. In these reports, valve lesions identified included 111,300 (9.08%) aortic stenosis, 20,246 (1.65%) mitral stenosis, 397 (0.03%) tricuspid stenosis, 2585 (0.21%) pulmonic stenosis, 345,115 (28.17%) aortic regurgitation, 802,103 (65.46%) mitral regurgitation, 903,965 (73.78%) tricuspid regurgitation, and 286,903 (23.42%) pulmonic regurgitation. Among the valves, 50,507 (4.12%), 22,656 (1.85%), 1685 (0.14%), and 1767 (0.14%) were identified as prosthetic aortic valves, mitral valves, tricuspid valves, and pulmonic valves, respectively. Mild and moderate were the most common severity levels of heart valve stenosis, while trace and mild were the most common severity levels of regurgitation. Males had a higher frequency of aortic stenosis and all 4 valvular regurgitations, while females had more mitral, tricuspid, and pulmonic stenosis. Non-Hispanic Whites had the highest frequency of all 4 valvular stenosis and regurgitations. The distribution of valvular stenosis and regurgitation severity was similar across race/ethnicity groups. Frequencies of aortic stenosis, mitral stenosis, and regurgitation of all 4 heart valves increased with age. In TTE reports with stenosis detected, younger patients were more likely to have mild aortic stenosis, while older patients were more likely to have severe aortic stenosis. However, mitral stenosis was opposite (milder in older patients and more severe in younger patients). In TTE reports with regurgitation detected, younger patients had a higher frequency of severe/very severe aortic regurgitation. In comparison, older patients had higher frequencies of mild","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"8 ","pages":"e60503"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11474122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346959","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":"Smart Device Ownership and Use of Social Media, Wearable Trackers, and Health Apps Among Black Women With Hypertension in the United States: National Survey Study.","authors":"Jolaade Kalinowski, Sandesh Bhusal, Sherry L Pagoto, Robert Newton, Molly E Waring","doi":"10.2196/59243","DOIUrl":"10.2196/59243","url":null,"abstract":"<p><p>The majority of Black women with hypertension in the United States have smartphones or tablets and use social media, and many use wearable activity trackers and health or wellness apps, digital tools that can be used to support lifestyle changes and medication adherence.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"8 ","pages":"e59243"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11420575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287582","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":"A co-design case study of the development of heart failure e-TIPS to support self-management.","authors":"Caleb Ferguson, Scott William, Sabine M Allida, Jordan Fulcher, Alicia J Jenkins, Jo-Dee Lattimore, L-J Loch, Anthony Keech","doi":"10.2196/57328","DOIUrl":"10.2196/57328","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a complex syndrome associated with high morbidity and mortality and increased healthcare utilisation. Patient education is key to improving health outcomes, achieved by promoting self-management to optimise medical management. Newer digital tools like text messaging and smartphone applications provide novel patient education approaches.</p><p><strong>Objective: </strong>To partner with clinicians and people with lived experience of HF to identify the priority educational topic areas to inform the development and delivery of a bank of electronic-message driven tips ('e-TIPS') to support HF self-management.</p><p><strong>Methods: </strong>We conducted three focus groups with cardiovascular clinicians, people with lived experience of HF and their caregivers, which consisted of two stages: Stage 1 - an exploratory qualitative study to identify the unmet educational needs of people living with HF (previously reported) and Stage 2 - a co-design feedback session to identify educational topic areas and inform the delivery of e-TIPS. This paper reports the findings of the co-design feedback session.</p><p><strong>Results: </strong>We identified five key considerations in delivering e-TIPS and five relevant HF educational topics for their content. Key considerations in e-TIP delivery included: (i) Timing of the e-TIPS; (ii) Clear and concise e-TIPS; (iii) Embedding a feedback mechanism; (iv) Distinguishing actionable and non-actionable e-TIPS; and (v) Frequency of e-TIP delivery. Relevant educational topic areas included: (i) cardiovascular risk reduction; (ii) Self-management; (iii) Food and nutrition; (iv) Sleep hygiene; and (v) Mental health.</p><p><strong>Conclusions: </strong>The findings from this co-design case study have provided a foundation for developing a bank of e-TIPS. These will now be evaluated for usability in the BANDAIDS e-TIPS, a single group, quasi-experimental study of a 24-week e-TIP program (personalised educational messages) delivered via Short Message Service (ACTRN12623000644662).</p><p><strong>Clinicaltrial: </strong></p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a New Telemedicine System for Early Detection of Cardiac Instability in Patients With Chronic Heart Failure: Real-Life Out-of-Hospital Study.","authors":"Jean Marie Urien, Emmanuelle Berthelot, Pierre Raphael, Thomas Moine, Marie Emilie Lopes, Patrick Assayag, Patrick Jourdain","doi":"10.2196/52648","DOIUrl":"10.2196/52648","url":null,"abstract":"<p><strong>Background: </strong>For a decade, despite results from many studies, telemedicine systems have suffered from a lack of recommendations for chronic heart failure (CHF) care because of variable study results. Another limitation is the hospital-based architecture of most telemedicine systems. Some systems use an algorithm based on daily weight, transcutaneous oxygen measurement, and heart rate to detect and treat acute heart failure (AHF) in patients with CHF as early on as possible.</p><p><strong>Objective: </strong>The aim of this study is to determine the efficacy of a telemonitoring system in detecting clinical destabilization in real-life settings (out-of-hospital management) without generating too many false positive alerts.</p><p><strong>Methods: </strong>All patients self-monitoring at home using the system after a congestive AHF event treated at a cardiology clinic in France between March 2020 and March 2021 with at least 75% compliance on daily measurements were included retrospectively. New-onset AHF was defined by the presence of at least 1 of the following criteria: transcutaneous oxygen saturation loss, defined as a transcutaneous oxygen measurement under 90%; rise of cardiac frequency above 110 beats per minute; weight gain of at least 2 kg; and symptoms of congestive AHF, described over the phone. An AHF alert was generated when the criteria reached our definition of new-onset acute congestive heart failure (HF).</p><p><strong>Results: </strong>A total of 111 consecutive patients (n=70 men) with a median age of 76.60 (IQR 69.5-83.4) years receiving the telemonitoring system were included. Thirty-nine patients (35.1%) reached the HF warning level, and 28 patients (25%) had confirmed HF destabilization during follow-up. No patient had AHF without being detected by the telemonitoring system. Among incorrect AHF alerts (n=11), 5 patients (45%) had taken inaccurate measurements, 3 patients (27%) had supraventricular arrhythmia, 1 patient (9%) had a pulmonary bacterial infection, and 1 patient (9%) contracted COVID-19. A weight gain of at least 2 kg within 4 days was significantly associated with a correct AHF alert (P=.004), and a heart rate of more than 110 beats per minute was more significantly associated with an incorrect AHF alert (P=.007).</p><p><strong>Conclusions: </strong>This single-center study highlighted the efficacy of the telemedicine system in detecting and quickly treating cardiac instability complicating the course of CHF by detecting new-onset AHF as well as supraventricular arrhythmia, thus helping cardiologists provide better follow-up to ambulatory patients.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"8 ","pages":"e52648"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11350300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971164","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, Acceptability, and Preliminary Effectiveness of a Combined Digital Platform and Community Health Worker Intervention for Patients With Heart Failure: Pilot Randomized Controlled Trial.","authors":"Jocelyn A Carter Carter, Natalia Swack, Eric Isselbacher, Karen Donelan, Anne Thorndike","doi":"10.2196/59948","DOIUrl":"10.2196/59948","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a burdensome condition and a leading cause of 30-day hospital readmissions in the United States. Clinical and social factors are key drivers of hospitalization. These 2 strategies, digital platforms and home-based social needs care, have shown preliminary effectiveness in improving adherence to clinical care plans and reducing acute care use in HF. Few studies, if any, have tested combining these 2 strategies in a single intervention.</p><p><strong>Objective: </strong>This study aims to perform a pilot randomized controlled trial assessing the acceptability, feasibility, and preliminary effectiveness of a 30-day digitally-enabled community health worker (CHW) intervention in HF.</p><p><strong>Methods: </strong>Adults hospitalized with a diagnosis of HF at an academic hospital were randomly assigned to receive digitally-enabled CHW care (intervention; digital platform +CHW) or CHW-enhanced usual care (control; CHW only) for 30 days after hospital discharge. Primary outcomes were feasibility (use of the platform) and acceptability (willingness to use the platform in the future). Secondary outcomes assessed preliminary effectiveness (30-day readmissions, emergency department visits, and missed clinic appointments).</p><p><strong>Results: </strong>A total of 56 participants were randomized (control: n=31; intervention: n=25) and 47 participants (control: n=28; intervention: n=19) completed all trial activities. Intervention participants who completed trial activities wore the digital sensor on 78% of study days with mean use of 11.4 (SD 4.6) hours/day, completed symptom questionnaires on 75% of study days, used the blood pressure monitor 1.1 (SD 0.19) times/day, and used the digital weight scale 1 (SD 0.13) time/day. Of intervention participants, 100% responded very or somewhat true to the statement \"If I have access to the [platform] moving forward, I will use it.\" Some (n=9, 47%) intervention participants indicated they required support to use the digital platform. A total of 19 (100%) intervention participants and 25 (89%) control participants had ≥5 CHW interactions during the 30-day study period. All intervention (n=19, 100%) and control (n=26, 93%) participants who completed trial activities indicated their CHW interactions were \"very satisfying.\" In the full sample (N=56), fewer participants in the intervention group were readmitted 30 days after hospital discharge compared to the control group (n=3, 12% vs n=8, 26%; P=.12). Both arms had similar rates of missed clinic appointments and emergency department visits.</p><p><strong>Conclusions: </strong>This pilot trial of a digitally-enabled CHW intervention for HF demonstrated feasibility, acceptability, and a clinically relevant reduction in 30-day readmissions among participants who received the intervention. Additional investigation is needed in a larger trial to determine the effect of this intervention on HF home management and clinical ","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":" ","pages":"e59948"},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498101","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":"Contactless and Calibration-Free Blood Pressure and Pulse Rate Monitor for Screening and Monitoring of Hypertension: Cross-Sectional Validation Study.","authors":"Melissa Kapoor, Blair Holman, Carolyn Cohen","doi":"10.2196/57241","DOIUrl":"10.2196/57241","url":null,"abstract":"<p><strong>Background: </strong>The key to reducing the immense morbidity and mortality burdens of cardiovascular diseases is to help people keep their blood pressure (BP) at safe levels. This requires that more people with hypertension be identified, diagnosed, and given tools to lower their BP. BP monitors are critical to hypertension diagnosis and management. However, there are characteristics of conventional BP monitors (oscillometric cuff sphygmomanometers) that hinder rapid and effective hypertension diagnosis and management. Calibration-free, software-only BP monitors that operate on ubiquitous mobile devices can enable on-demand BP monitoring, overcoming the hardware barriers of conventional BP monitors.</p><p><strong>Objective: </strong>This study aims to investigate the accuracy of a contactless BP monitor software app for classifying the full range of clinically relevant BPs as hypertensive or nonhypertensive and to evaluate its accuracy for measuring the pulse rate (PR) and BP of people with BPs relevant to stage-1 hypertension.</p><p><strong>Methods: </strong>The software app, known commercially as Lifelight, was investigated following the data collection and data analysis methodology outlined in International Organization for Standardization (ISO) 81060-2:2018/AMD 1:2020 \"Non-invasive Sphygmomanometers-Part 2: Clinical investigation of automated measurement type.\" This validation study was conducted by the independent laboratory Element Materials Technology Boulder (formerly Clinimark). The study generated data from 85 people aged 18-85 years with a wide-ranging distribution of BPs specified in ISO 81060-2:2018/AMD 1:2020. At least 20% were required to have Fitzpatrick scale skin tones of 5 or 6 (ie, dark skin tones). The accuracy of the app's BP measurements was assessed by comparing its BP measurements with measurements made by dual-observer manual auscultation using the same-arm sequential method specified in ISO 81060-2:2018/AMD 1:2020. The accuracy of the app's PR measurements was assessed by comparing its measurements with concurrent electroencephalography-derived heart rate values.</p><p><strong>Results: </strong>The app measured PR with an accuracy root-mean-square of 1.3 beats per minute and mean absolute error of 1.1 (SD 0.8) beats per minute. The sensitivity and specificity with which it determined that BPs exceeded the in-clinic systolic threshold for hypertension diagnosis were 70.1% and 71.7%, respectively. These rates are consistent with those reported for conventional BP monitors in a literature review by The National Institute for Health and Care Excellence. The app's mean error for measuring BP in the range of normotension and stage-1 hypertension (ie, 65/85, 76% of participants) was 6.5 (SD 12.9) mm Hg for systolic BP and 0.4 (SD 10.6) mm Hg for diastolic BP. Mean absolute error was 11.3 (SD 10.0) mm Hg and 8.6 (SD 6.8) mm Hg, respectively.</p><p><strong>Conclusions: </strong>A calibration-free, software-only medi","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"8 ","pages":"e57241"},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11333865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889237","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":"Analysis of Demographic and Socioeconomic Factors Influencing Adherence to a Web-Based Intervention Among Patients After Acute Coronary Syndrome: Prospective Observational Cohort Study.","authors":"Biagio Sassone, Giuseppe Fuca', Mario Pedaci, Roberta Lugli, Enrico Bertagnin, Santo Virzi', Manuela Bovina, Giovanni Pasanisi, Simona Mandini, Jonathan Myers, Paolo Tolomeo","doi":"10.2196/57058","DOIUrl":"10.2196/57058","url":null,"abstract":"<p><strong>Background: </strong>Although telemedicine has been proven to have significant potential for improving care for patients with cardiac problems, there remains a substantial risk of introducing disparities linked to the use of digital technology, especially for older or socially vulnerable subgroups.</p><p><strong>Objective: </strong>We investigated factors influencing adherence to a telemedicine-delivered health education intervention in patients with ischemia, emphasizing demographic and socioeconomic considerations.</p><p><strong>Methods: </strong>We conducted a descriptive, observational, prospective cohort study in consecutive patients referred to our cardiology center for acute coronary syndrome, from February 2022 to January 2023. Patients were invited to join a web-based health educational meeting (WHEM) after hospital discharge, as part of a secondary prevention program. The WHEM sessions were scheduled monthly and used a teleconference software program for remote synchronous videoconferencing, accessible through a standard computer, tablet, or smartphone based on patient preference or availability.</p><p><strong>Results: </strong>Out of the 252 patients (median age 70, IQR 61.0-77.3 years; n=189, 75% male), 98 (38.8%) declined the invitation to participate in the WHEM. The reasons for nonacceptance were mainly challenges in handling digital technology (70/98, 71.4%), followed by a lack of confidence in telemedicine as an integrative tool for managing their medical condition (45/98, 45.9%), and a lack of internet-connected devices (43/98, 43.8%). Out of the 154 patients who agreed to participate in the WHEM, 40 (25.9%) were unable to attend. Univariable logistic regression analysis showed that the presence of a caregiver with digital proficiency and a higher education level was associated with an increased likelihood of attendance to the WHEM, while the converse was true for increasing age and female sex. After multivariable adjustment, higher education level (odds ratio [OR] 2.26, 95% CI 1.53-3.32; P<.001) and caregiver with digital proficiency (OR 12.83, 95% CI 5.93-27.75; P<.001) remained independently associated with the outcome. The model discrimination was good even when corrected for optimism (optimism-corrected C-index=0.812), as was the agreement between observed and predicted probability of participation (optimism-corrected calibration intercept=0.010 and slope=0.948).</p><p><strong>Conclusions: </strong>This study identifies a notable lack of suitability for a specific cohort of patients with ischemia to participate in our telemedicine intervention, emphasizing the risk of digital marginalization for a significant portion of the population. Addressing low digital literacy rates among patients or their informal caregivers and overcoming cultural bias against remote care were identified as critical issues in our study findings to facilitate the broader adoption of telemedicine as an inclusive tool in health care.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":" ","pages":"e57058"},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11329845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442722","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":"Identifying Predictors of Heart Failure Readmission in Patients From a Statutory Health Insurance Database: Retrospective Machine Learning Study.","authors":"Rebecca T Levinson, Cinara Paul, Andreas D Meid, Jobst-Hendrik Schultz, Beate Wild","doi":"10.2196/54994","DOIUrl":"10.2196/54994","url":null,"abstract":"<p><strong>Background: </strong>Patients with heart failure (HF) are the most commonly readmitted group of adult patients in Germany. Most patients with HF are readmitted for noncardiovascular reasons. Understanding the relevance of HF management outside the hospital setting is critical to understanding HF and factors that lead to readmission. Application of machine learning (ML) on data from statutory health insurance (SHI) allows the evaluation of large longitudinal data sets representative of the general population to support clinical decision-making.</p><p><strong>Objective: </strong>This study aims to evaluate the ability of ML methods to predict 1-year all-cause and HF-specific readmission after initial HF-related admission of patients with HF in outpatient SHI data and identify important predictors.</p><p><strong>Methods: </strong>We identified individuals with HF using outpatient data from 2012 to 2018 from the AOK Baden-Württemberg SHI in Germany. We then trained and applied regression and ML algorithms to predict the first all-cause and HF-specific readmission in the year after the first admission for HF. We fitted a random forest, an elastic net, a stepwise regression, and a logistic regression to predict readmission by using diagnosis codes, drug exposures, demographics (age, sex, nationality, and type of coverage within SHI), degree of rurality for residence, and participation in disease management programs for common chronic conditions (diabetes mellitus type 1 and 2, breast cancer, chronic obstructive pulmonary disease, and coronary heart disease). We then evaluated the predictors of HF readmission according to their importance and direction to predict readmission.</p><p><strong>Results: </strong>Our final data set consisted of 97,529 individuals with HF, and 78,044 (80%) were readmitted within the observation period. Of the tested modeling approaches, the random forest approach best predicted 1-year all-cause and HF-specific readmission with a C-statistic of 0.68 and 0.69, respectively. Important predictors for 1-year all-cause readmission included prescription of pantoprazole, chronic obstructive pulmonary disease, atherosclerosis, sex, rurality, and participation in disease management programs for type 2 diabetes mellitus and coronary heart disease. Relevant features for HF-specific readmission included a large number of canonical HF comorbidities.</p><p><strong>Conclusions: </strong>While many of the predictors we identified were known to be relevant comorbidities for HF, we also uncovered several novel associations. Disease management programs have widely been shown to be effective at managing chronic disease; however, our results indicate that in the short term they may be useful for targeting patients with HF with comorbidity at increased risk of readmission. Our results also show that living in a more rural location increases the risk of readmission. Overall, factors beyond comorbid disease were relevant for risk of HF read","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"8 ","pages":"e54994"},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11318205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748189","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}