JMIR Cardio最新文献

{"title":"Cardiac Telerehabilitation Using a Smartwatch and a Gamified Smartphone App: Single-Arm Pre-Post Feasibility Study.","authors":"Yusaku Arima, Toshiki Kaihara, Megumi Nakamura, Keita Sone, Toshiya Yoshida, Yui Utsugi, Shiori Takizawa, Shunichi Doi, Kei Honda, Yoshikuni Kobayashi, Akira Kasagawa, Yasuhito Kawagoe, Takahiko Kai, Masashi Koga, Takumi Higuma, Yasuhiro Tanabe, Yoshihiro Akashi","doi":"10.2196/85808","DOIUrl":"10.2196/85808","url":null,"abstract":"<p><strong>Background: </strong>Home-based cardiac rehabilitation (CR) using digital health technologies (ie, cardiac telerehabilitation [CTR]) has emerged as a practical alternative to conventional center-based CR, particularly during and after the COVID-19 pandemic. However, maintaining sustained participation in CR remains challenging. Gamification holds the potential to enhance motivation and adherence in CR, but its role in CTR for patients with acute coronary syndrome (ACS) remains under-studied.</p><p><strong>Objective: </strong>This feasibility study evaluated the feasibility, acceptability, and safety of a combination of a gamification-enabled smartphone app and a smartwatch supporting CTR after ACS. We focused specifically on participation motivation, adherence to prescribed exercise intensity, and short-term physiological outcomes.</p><p><strong>Methods: </strong>This single-arm, pre-post intervention study was conducted at 2 Japanese institutions. Sixteen patients diagnosed with ST-elevated myocardial infarction or non-ST-elevated myocardial infarction and undergoing percutaneous coronary intervention were enrolled after discharge. Each patient received a smartphone and smartwatch connected to the Shin-po Kei app, through which participants earned points when exercising within their target anaerobic threshold heart rate (HR) range (±10 bpm). The 1-month intervention prescribed walking for 30 minutes or longer 3 to 5 days or more per week, at an intensity corresponding to a Borg scale score of 11 to 13. The primary end point was the number of app log-in days divided by the number of intervention days (app use rate). Secondary end points included the target HR exercise adherence rate (defined as the proportion of patients who exercised for 30 minutes within the target HR range on 3 or more days per week), changes in peak oxygen consumption, and changes in perceived exertion using a visual analog scale.</p><p><strong>Results: </strong>The mean patient age was 62 (SD 13) years, and 94% (15/16) were male. The mean intervention duration was 29 (SD 6) days, and the overall app use rate was 59.9%. The target HR exercise adherence rate was 50%. Peak oxygen consumption increased from 18.4 (SD 4.1) to 21.1 (SD 5.4) mL/kg/min, and the mean visual analog scale score for exercise-related hassle reduced from 57 (SD 33) to 32 (SD 26). No adverse events related to app use were identified, and 1 hospitalization unrelated to the intervention occurred during the study period.</p><p><strong>Conclusions: </strong>This feasibility study suggests that short-term engagement with a smartwatch-linked gamified smartphone app is achievable in CTR after ACS. However, adherence to predefined gamified exercise standards was lower than app use rates, suggesting that refinement of reward rules and target HR thresholds may be necessary.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e85808"},"PeriodicalIF":2.4,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13256502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148225412","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":"Experiences of Patients With Atrial Fibrillation Using Technology to Personalize Self-Care Decision-Making: Interpretive Description Study.","authors":"Kathy L Rush, Cherisse L Seaton, Alexandra Lukey, Victor Wang, Peter S Loewen, Wynne Chiu, Megan Patapoff, Lana Moroz, Jason G Andrade","doi":"10.2196/93036","DOIUrl":"10.2196/93036","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is a challenging chronic disease to manage. Patients' daily self-care decisions are associated with improved AF outcomes, quality of life, and decreased hospital use and cost. However, many patients find these real-world or naturalistic decisions difficult, often because of their inherent complexity and ambiguity, coupled with the uncertainty of AF. Intervention research using technology to support AF self-care has largely emphasized making decisions with clinicians. Patients with AF are increasingly using consumer technology; yet, little is known about the use of technology by patients with AF in independent self-care decision-making. Addressing this gap will facilitate developing interventions that better leverage technology to enhance patients' naturalistic decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to explore the experiences of older adult patients in using technology to support self-care decision-making.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Following an interpretive descriptive qualitative approach, older adult patients with AF were recruited from 3 specialty heart function clinics in a Western Canadian province to participate in 1 of 6 facilitated virtual focus groups for 1.5 hours. Patients were asked about their self-care decision-making since AF diagnosis, their AF-specific technology use and its use in making self-care decisions, their technology motivations, benefits, constraints, and other possibilities for use. Inductive thematic analysis was used to code the transcribed data, moving from open coding to clustering of common codes into categories, looking for patterns of meaning between and across categories to iteratively arrive at main themes and subthemes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty patients (n=15, 50% women) with AF (mean age, 73, SD 5.7 years; range 63-85 years) participated in the focus groups. Participants' experiences of using technology to make daily self-care decisions were highly variable but centered on its personalized use to meet their individualized needs, preferences, and life context. The personalizing process of technology use in decision-making was characterized by three themes: (1) beginning technology use in their own times and ways, during their AF trajectory-pre-, at the time, at some point AF post diagnosis, and could be either self-initiated and/or provider recommended or influenced; (2) developing patterns of AF self-care decision-making using technology, including establishing their personal baseline, keeping out of the danger zone, watchful waiting, and seeking decision-making support; and (3) finding the place for technology in normalizing daily life, either settling on or limiting its use to normalize life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Findings expand understandings of naturalistic decision-making by elucidating the personalized process of technology use in","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e93036"},"PeriodicalIF":2.4,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13256484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148225430","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":"Patient Perceptions of a Digitally Enabled Community Health Worker Intervention: Qualitative Study Among Pilot Trial Participants.","authors":"Jocelyn Carter, Natalia Swack, Narmeen Rehman, Yadira Reyes-Richards, Karen Donelan, Anne Thorndike","doi":"10.2196/93288","DOIUrl":"10.2196/93288","url":null,"abstract":"<p><strong>Background: </strong>Most studies assessing digital interventions for people with heart failure (HF) focus on clinical outcomes, and few include patient perspectives. Understanding patient experiences of the use of a digital HF platform along with community health worker (CHW) care as part of a digitally enabled CHW intervention can inform management of HF at home and improve the postdischarge phase of care.</p><p><strong>Objective: </strong>This study aimed to identify patient perceptions related to the use of a digitally enabled CHW intervention.</p><p><strong>Methods: </strong>This qualitative study included interviews with adults (aged ≥18 years) with HF who were assigned to the intervention arm of a pilot randomized controlled trial from September 2022 to June 2023. For 30 days after hospital discharge, intervention participants were paired with a CHW and instructed to use a digital platform that tracked biometrics (eg, heart rate, oxygenation, blood pressure, body weight, steps taken, and symptoms) and offered educational videos. In-depth interviews were conducted after the 30-day intervention was complete (between 31 and 45 days after hospital discharge). Key interview domains included barriers and facilitators to the intervention, use of remote monitoring in HF, and the role of CHWs in HF home care.</p><p><strong>Results: </strong>Interviews with participants (N=19; mean age 62.1, SD 15.1 years) yielded five key themes: (1) the combined intervention was well received, and CHWs made the use of the digital platform more approachable; (2) the digital platform enhanced HF knowledge and confidence in self-care; (3) digital platform use was easy to integrate into daily routines; (4) in addition to assisting with navigation of unmet social needs (eg, transportation, insurance benefits, and food access), CHWs provided emotional support and increased motivation for clinical care plan adherence and platform use; and (5) connectivity issues and other technical challenges occurred with digital platform use.</p><p><strong>Conclusions: </strong>The digital platform was easily integrated into patients' daily routines. CHWs played a key role in making the platform more approachable for participant use. Further research is needed to better understand the impact of this intervention in larger HF populations over more extended time intervals.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e93288"},"PeriodicalIF":2.4,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163240","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":"Smartphone Ownership Among Cardiology Inpatients Pre-COVID-19 and Post-COVID-19 Pandemic: Secondary Analysis of Randomized Controlled Trials.","authors":"Sarah Badger, Praveen Indraratna, Jennifer Yu, James McVeigh, Joseph Magdy, Joan Li, Nigel Lovell, Sze-Yuan Ooi","doi":"10.2196/77141","DOIUrl":"10.2196/77141","url":null,"abstract":"<p><strong>Background: </strong>Mobile health (mHealth) interventions are increasing in popularity for the management of heart failure and coronary artery disease. The use of these interventions is dependent on rates of smartphone ownership. It is estimated that approximately 90% of the Australian adult population owns a smartphone; however, international studies suggest that smartphone ownership is significantly lower in patient populations, ranging from 34% to 91%. Smartphone ownership in patients with cardiovascular disease has not previously been examined.</p><p><strong>Objective: </strong>This study aimed to examine and compare pre-COVID-19 and post-COVID-19 pandemic smartphone ownership rates of inpatients admitted with coronary artery disease or heart failure.</p><p><strong>Methods: </strong>Data from prescreening logs of 2 multicenter randomized controlled trials, TeleClinical Care (TCC)-Pilot and TCC-Cardiac, were reviewed. TCC-Pilot recruited patients between February 2019 and March 2020. This formed the pre-COVID-19 cohort, with 377 patients screened who lived in Sydney, had a qualifying hospital admission, and had information regarding their phone ownership status. TCC-Cardiac recruited patients from July 2021 to February 2023, with 718 patients meeting the criteria and forming the post-COVID-19 cohort. Supplemental patient demographic and medical history data were collected from the electronic medical record.</p><p><strong>Results: </strong>In the pre-COVID-19 cohort (N=377), 194 (51.5%) patients owned smartphones, 79 (21%) owned phones that were incompatible with the mHealth intervention, and the remaining 104 (27.6%) did not own a mobile phone. Smartphone owners were predominantly male (P<.001) and more often had private health insurance (P=.002). In the post-COVID-19 cohort (N=718), 366 (51%) patients owned smartphones, 106 (14.8%) owned incompatible phones, and the remaining 246 (34.3%) did not own any mobile phone. In both cohorts, younger patients were more likely to own smartphones (P<.001). Multiple comorbidities were associated with not owning a phone.</p><p><strong>Conclusions: </strong>Smartphone ownership accounted for just over 50% of the patients in this population. It was less common among older adults, patients with comorbidities, and those with markers of lower socioeconomic status. This needs to be considered when delivering mHealth interventions.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e77141"},"PeriodicalIF":2.4,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13229392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149667","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":"Positive Psychological Well-Being and Determinants of Social Robot Acceptability Among Patients With Heart Failure: Cross-Sectional Questionnaire Study.","authors":"Lisa-Marie Maukel, Karen Bouchard, Jess G Fiedorowicz, Kerstin Dautenhahn, Moojan Ghafurian, Thais Coutinho, Caroline McGuinty, Peter P Liu, Heather Tulloch","doi":"10.2196/83163","DOIUrl":"10.2196/83163","url":null,"abstract":"<p><strong>Background: </strong>Social robots (SRs) are innovative tools in health care, offering both medical and psychological support for patients with heart failure (HF). For successful implementation, patient acceptability of SRs is crucial. Living in urban areas and having a lower comorbidity burden have been linked to higher acceptability; however, the role of psychological factors remains underexplored.</p><p><strong>Objective: </strong>This study aimed to examine the associations between negative (eg, depression and anxiety) and positive (eg, optimism) psychological factors and personality traits (eg, openness and extraversion) with SR acceptability in patients with HF.</p><p><strong>Methods: </strong>Patients with HF watched brief videos about SRs and completed validated measures of depressive symptoms (Patient Health Questionnaire-9), anxiety symptoms (Generalized Anxiety Disorder-7), positive psychological well-being (Brief Inventory of Thriving), and personality traits (Ten-Item Personality Inventory). Medical information was extracted from patients' records. SR acceptability was assessed using the Unified Theory of Acceptance and Use of Technology (UTAUT). Pearson correlations and multiple linear regression, adjusted for age, sex, smart technology experience, urbanicity, and comorbidities, were conducted.</p><p><strong>Results: </strong>Of the 101 patients (women: n=36, 35.6%, mean age 68, SD 10 y), 23% (23/101) scored in the clinical range for depression, and 17% (17/101) scored in the clinical range for anxiety. Well-being scores were moderate, and conscientiousness and agreeableness were the most common. UTAUT behavioral intention was moderate; 69% (67/97) of participants were likely to use an SR if available. Well-being scores correlated positively with SR acceptability in 4 of 5 UTAUT subscales, whereas no significant bivariate associations were observed for psychological distress or personality traits. In the multiple regression models, higher Brief Inventory of Thriving scores were associated with increased SR acceptability, including UTAUT facilitating conditions (B=0.17; P=.01) and behavioral intention (B=0.17; P=.04), independent of depressive and anxiety symptoms.</p><p><strong>Conclusions: </strong>Psychological well-being is associated with determinants of SR acceptability in patients with HF, while psychological distress and personality traits are not associated with these determinants. These patient-level factors ought to be examined more closely before SR implementation.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e83163"},"PeriodicalIF":2.4,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13229465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148149723","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 Facilitators to Maintaining Physical Activity After an mHealth Intervention for People Poststroke or Transient Ischemic Attack: Reflexive Thematic Analysis.","authors":"Hanna Lagerlund, David Moulaee Conradsson, Charlotte K Häger, Lydia Kwak, Lisa Holmlund","doi":"10.2196/87493","DOIUrl":"10.2196/87493","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Regular physical activity is critical for preventing secondary stroke following a stroke or transient ischemic attack (TIA). Although mobile health (mHealth) interventions have shown promise for promoting short-term increases in physical activity, evidence on their long-term effects and the mechanisms that support sustained behavior change remains limited. In particular, little is known about how people poststroke or TIA integrate the skills, knowledge, and habits gained through mHealth interventions into their daily lives once structured intervention support ends.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to explore the perceived barriers and facilitators of maintaining physical activity among individuals poststroke or TIA after completing an mHealth intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A qualitative approach was used, involving a strategic sample of 12 participants recruited after they had completed a 6-month mHealth intervention for people poststroke or TIA. The intervention included supervised physical therapy with mHealth support for physical exercises and behavior change (eg, counseling, goal-setting, and self-monitoring), followed by a 6-month postintervention period with access to self-managed mHealth support. To enable richness and depth in participants' accounts, the dataset consisted of 2 semistructured interviews conducted 3 months and 6 months after completing the intervention, along with participant-generated photographs. Between the interviews, participants took photos to reflect their experiences of maintaining physical activity after the intervention. These images served as prompts for dialog and reflection during the second interview. Data were analyzed using reflexive thematic analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We generated 3 themes: building experience and knowledge to maintain physical activity, staying physically active in a complex life situation, and the meaning of context for maintaining physical activity after the intervention. Barriers and facilitators were conceptually integrated into a comprehensive understanding of maintaining physical activity, symbolized by the metaphor of a soap bubble, which requires persistence and a supportive environment to stay afloat. The complexity of participants' health and life situations created barriers to maintaining physical activity. To overcome these barriers, developing personal strategies within a supportive social and physical context was crucial. This development was facilitated by the mHealth intervention, which enabled knowledge acquisition of the principles of physical activity after stroke or TIA, along with increased awareness of its health benefits.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;mHealth interventions for people poststroke and TIA can serve as a catalyst for physical activity engagement and an enhancer of the knowledge and experience necessary to maintain physical activity after the intervention. Despite health","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e87493"},"PeriodicalIF":2.4,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13215576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042388","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":"Sleep and Cardiovascular Health Among Women With a History of Hypertensive Disorders of Pregnancy: Pilot Observational Study.","authors":"Anais Hausvater, Elianna Shwayder, Marie-Pierre St-Onge, Linda G Kahn, Manuela Plazas-Montana, Lillian Na, Amanda Joa, Leonardo Trasande, Harmony R Reynolds","doi":"10.2196/81118","DOIUrl":"10.2196/81118","url":null,"abstract":"<p><strong>Background: </strong>Both poor sleep health and hypertensive disorders of pregnancy (HDP) are independent risk factors for cardiovascular disease. Whether poor postpartum sleep contributes to the relationship between HDP and future cardiovascular disease is unknown. This pilot study evaluated the feasibility and acceptability of studying sleep health using a wearable device (Oura ring) among mothers of young children.</p><p><strong>Objective: </strong>We evaluated indices of sleep health both objectively with the Oura ring and subjectively via questionnaires and qualitative interviews among mothers with and without a history of HDP. We also aimed to compare cardiovascular health (CVH) among mothers with vs without a prior history of HDP.</p><p><strong>Methods: </strong>Women who were 3 to 7 years after childbirth completed baseline questionnaires (the Pittsburgh Sleep Quality Index [PSQI], Mediterranean Eating Pattern for Americans tool, and 7-item International Physical Activity Questionnaire) and wore the Oura ring continuously for 2 weeks to monitor sleep. Optimal sleep health was defined as a sleep duration of ≥7 hours, a PSQI score of ≤5, sleep timing with a sleep midpoint between 2 AM and 4 AM, a sleep efficiency of >85%, and a sleep onset variability of <60 minutes. CVH was assessed using the Life's Essential 8 score, with 8 factors assessed via questionnaires (diet, physical activity, and nicotine exposure) and objective measurements (BMI, blood pressure, blood lipids, blood glucose, and sleep duration). Semistructured interviews were conducted.</p><p><strong>Results: </strong>In total, among 49 women, 28 (57%) with prior HDP and 21 (43%) with prior normotensive pregnancy were included, with an average of 4.9 (SD 1.2) years after delivery. Average sleep quality was suboptimal in both groups (mean PSQI score 7.0, SD 3.5 in the HDP group vs mean PSQI score 5.9, SD 2.4 in the control group; P=.22). Average sleep duration was suboptimal (6.7, SD 0.8 hours), with no difference between groups. Approximately half (n=23, 47%) had abnormal sleep timing, which was more common among those with a prior normotensive pregnancy. Sleep onset variability was high (mean 1.2, SD 0.5 hours), with no significant differences by HDP status. The mean CVH score fell within the moderate range (70.7, SD 12.8), with no differences between groups. The components of the CVH score that were lowest (ie, worst) among the entire cohort were diet (mean 37.3, SD 25.6) and BMI (mean 50.8, SD 35.4 kg/m2). Common barriers to sleep included parenting, work, and household responsibilities. The study met our criteria for the feasibility and acceptability of using the Oura ring to study sleep in this population.</p><p><strong>Conclusions: </strong>Among postpartum women, sleep health was suboptimal regardless of HDP history. Interventions to improve sleep and CVH should target all mothers during the first decade after childbirth.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e81118"},"PeriodicalIF":2.4,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13211945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148030570","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":"Extracting Cardiorespiratory Symptoms From Clinical Notes Using Open-Weight Large Language Models: Method Development and Validation Study.","authors":"Yunbing Bai, Wanting Cui, Joseph Finkelstein","doi":"10.2196/89480","DOIUrl":"10.2196/89480","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Accurate identification of clinical symptoms and signs (S&S) is essential for the early detection of high-burden cardiorespiratory conditions, including lung cancer, chronic obstructive pulmonary disease, and heart failure. Although symptom data play a central role in diagnostic reasoning and predictive modeling, most S&S information remains embedded in unstructured electronic health record notes, limiting their use in automated phenotyping, surveillance, and clinical decision support. Traditional natural language processing systems struggle with domain variability and contextual nuance in clinical text. Recent advances in large language models (LLMs) offer a promising alternative, yet challenges remain in hallucinations, overinference, and safe deployment. This study evaluated whether locally deployed open-source models could reliably extract cardiorespiratory S&S and map them to ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) codes using optimized prompting strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to assess the accuracy of open-source LLMs in extracting explicitly stated cardiorespiratory S&S from clinical notes and mapping them to ICD-10-CM codes (R00-R09) and to compare performance across 4 prompt-engineering strategies, including a multimodule LLM framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 593 clinical notes from the MTSamples database were manually reviewed, with 93 notes used for prompt development and comparison using Llama 3.3-70B, and 500 notes used as testing data for the final best prompt setting using both Llama 3.3-70B and gpt-oss-120B. Four prompting conditions were evaluated: (1) instruction-only, (2) ICD-10-CM definition-based prompts, (3) assumption-free prompts, and (4) a multimodule LLM framework with postprocessing. Performance was measured using precision, recall, and F1-score for both S&S extraction and ICD-10-CM code generation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Across all prompt strategies, model performance improved as more structure and constraints were added. Instruction-only prompting demonstrated high recall but poor precision. Incorporating ICD-10-CM definitions improved coding accuracy, and assumption-free prompting further balanced precision and recall. The multimodule approach with postprocessing achieved the highest performance during prompt development. On the independent test corpus, entity-level microaveraged evaluation showed that gpt-oss-120B outperformed Llama 3.3-70B in both tasks. For S&S extraction, Llama 3.3-70B achieved a precision of 0.63, a recall of 0.86, and an F1-score of 0.73, whereas gpt-oss-120B achieved a precision of 0.89, a recall of 0.87, and an F1-score of 0.88. For ICD-10-CM code mapping, Llama 3.3-70B achieved a precision of 0.59, a recall of 0.83, and an F1-score of 0.69, whereas gpt-oss-120B achieved a precision of 0.90, a recall of 0.84, and an F1-score of 0.87.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Con","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e89480"},"PeriodicalIF":2.4,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13216758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042374","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":"Postangiography Prediction of Renal Replacement Therapy in Acute Myocardial Infarction-Related Cardiogenic Shock: Least Absolute Shrinkage and Selection Operator Nomogram Development and Validation.","authors":"Amin Daoulah, Julia M Ladna, Abdulrahman Arabi, Ahmed Elmahrouk, Shaber Seraj, Hatem M Aloui, Mohammed Alshehri, Wael Almahmeed, Prashanth Panduranga, Nooraldaem Yousif, Amir Lotfi, Mohammed Qutub, Waleed Alharbi, Rajesh Rajan, Mokhtar Abdirahman Kahin, Abdullah Alenezi, Said Al Maashani, Taher Hassan, Jassim Alswuaidi, Fakhreldein Eltaieb, Mubarak Abdulhadi Aldossari, Mohammed Al Jarallah, Abdelmaksoud Elganady, Badr Alzahrani, Abdulrahman Alqahtani, Faisal Omar M Al Nasser, Husam A Noor, Mohamed Nabil Alama, Alaa Aldossari, Sultan Al Obaikan, Alsayed Ali Almarghany, Omar Kanbr, Youssef Elmahrouk, Ibrahim A M Abdulhabeeb, Mohammed Balghith, Ahmad S Hersi, Harvey Antony, Adnan Fathey Hussien, Abdulrahman Almoghairi, Mohamed Mohammednabil A Alama, Mohamed Ajaz Ghani, Hazim Rahbi, Ayman Basardah, Bandar Alshehri, Abdulhadi Alama, Laura AlObaid, Seraj Abualnaja, Tarique Shahzad Chachar, Hassan Khan, Shahrukh Hashmani, Ahmed A Ghonim, Khalid Almerri, Razan Alsofayan, Abdelaziz M Tawengi, Abeer M Shawky, Ali Alshehri, Amr Arafat, Ahmed Jamjoom","doi":"10.2196/79678","DOIUrl":"10.2196/79678","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury critically impacts outcomes in cardiogenic shock secondary to acute myocardial infarction (CS-AMI). Acute kidney injury is one of the strongest independent predictors of in-hospital mortality in CS-AMI. Despite evidence that early renal replacement therapy (RRT) initiation improves survival, comprehensive prediction models for RRT in this population remain lacking.</p><p><strong>Objective: </strong>This study aimed to develop and internally validate a Least Absolute Shrinkage and Selection Operator (LASSO) regression-based prediction model and clinical nomogram for in-hospital RRT in patients with CS-AMI.</p><p><strong>Methods: </strong>This multicenter retrospective cohort study included 1431 patients with CS-AMI from the Gulf Cardiogenic Shock (Gulf-CS) registry across 13 centers in 6 Gulf countries (2020-2022). LASSO logistic regression was applied to a training set (1071/1431, 80%) to select baseline predictors of RRT; performance was evaluated on a held-out testing set (268/1431, 20%). Internal validation included 10-fold cross-validation and bootstrapping (1000 iterations). Cluster-robust SEs accounted for center effects. The model was compared to a parsimonious model (age+creatinine clearance), and a clinical nomogram was developed.</p><p><strong>Results: </strong>Of 1431 patients, 190 (13.3%) required RRT. Patients requiring RRT were significantly older (mean 64.17, SD 12.14 y vs mean 59.75, SD 11.77 y; P<.001), with higher prevalences of diabetes mellitus (72.1% vs 61.9%; P=.008), peripheral arterial disease (11.6% vs 3.7%; P<.001), and prior cerebrovascular accident (11.1% vs 5.7%; P=.005). The RRT group had lower creatinine clearance (46 vs 72 mL/min; P<.001), higher baseline lactate (2.7 vs 2.1 mmol/L; P<.001), and more advanced Society for Cardiovascular Angiography and Interventions (SCAI) shock stages (stages D and E: 90.5% vs 64.9%; P<.001). LASSO selected 15 baseline predictors. The model achieved an area under the receiver operating characteristic curve (AUC) of 0.714 on the testing set, significantly outperforming the parsimonious model (AUC: 0.624; P<.001). Bootstrap-corrected AUC was 0.745 (95% CI 0.730-0.756). In-hospital mortality was markedly higher in the RRT group (75.8% vs 38.8%; P<.001), with longer hospital stay (10 vs 6 d; P<.001), more major bleeding (16.8% vs 7.3%; P<.001), and cerebrovascular accidents (11.1% vs 4.9%; P=.001).</p><p><strong>Conclusions: </strong>We have developed and internally validated a robust 15-variable nomogram (Gulf-CS-Nomogram) that accurately predicts the need for RRT in patients with CS-AMI using baseline data intended for use after coronary angiography. This tool may facilitate early nephrology consultation and timely RRT initiation to improve outcomes.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"10 ","pages":"e79678"},"PeriodicalIF":2.4,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981810","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":"Patient Perceptions of a Digitally-Enabled Community Health Worker Intervention: A Qualitative Study.","authors":"Jocelyn Carter, Natalia Swack, Narmeen Rehman, Yadira Reyes-Richards, Karen Donelan, Anne Thorndike","doi":"10.2196/93288","DOIUrl":"10.2196/93288","url":null,"abstract":"<p><strong>Background: </strong>Most studies assessing digital interventions for people with heart failure (HF) focus on clinical outcomes and few include patient perspectives. Understanding patient experience with the use of a digital HF platform along with community health worker (CHW) care as part of a digitally-enabled CHW intervention, can inform management of HF at home and improve the post-discharge phase of care.</p><p><strong>Objective: </strong>To identify patient perceptions related to the use of a digitally-enabled community health worker intervention.</p><p><strong>Methods: </strong>This qualitative study includes interviews with adults (age ≥18) with HF who were assigned to the intervention arm of a pilot randomized controlled trial September 2022 through June 2023. For 30 days after hospital discharge, intervention participants were paired with a CHW and instructed to use a digital platform that tracked biometrics (e.g., heart rate, oxygenation, blood pressure, body weight, steps taken, symptoms) and offered educational videos. In-depth interviews were performed after the 30-day intervention was complete (between 31 to 45 days after hospital discharge). Key interview domains included: barriers and facilitators to the intervention, use of remote monitoring in HF, and the role of CHWs in HF home care.</p><p><strong>Results: </strong>Interviews with participants (N=19; mean age 62.1, SD 15.1 years) yielded five key themes: (1) The combined intervention was well-received and CHWs made the use of the digital platform more approachable; (2) The digital platform enhanced HF knowledge and confidence in self-care; (3) Digital platform use was easy to integrate into daily routines; (4) In addition to assisting with navigation of unmet social needs (e.g., transportation, insurance benefits, food access), CHWs provided emotional support and increased motivation for clinical care plan adherence and platform use; (5) Connectivity issues and other technical challenges occurred with digital platform use.</p><p><strong>Conclusions: </strong>The digital platform was easily integrated into patient daily routines. CHWs played a key role in making the platform more approachable for participant use. Further research is needed to better understand the impact of this intervention in larger HF populations over more extended time intervals.</p><p><strong>International registered report: </strong>RR2-10.2196/55687.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981805","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}