JMIR Cardio最新文献

{"title":"The Association Between Mobile App Use and Change in Functional Capacity Among Cardiac Rehabilitation Participants: Cohort Study.","authors":"Janah May Oclaman, Michelle L Murray, Donald J Grandis, Alexis L Beatty","doi":"10.2196/44433","DOIUrl":"10.2196/44433","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) is underused in the United States and globally, with participation disparities across gender, socioeconomic status, race, and ethnicities. The pandemic led to greater adoption of telehealth CR and mobile app use.</p><p><strong>Objective: </strong>Our primary objective was to estimate the association between CR mobile app use and change in functional capacity from enrollment to completion in patients participating in a CR program that offered in-person, hybrid, and telehealth CR. Our secondary objectives were to study the association between mobile app use and changes in blood pressure (BP) or program completion.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of participants enrolled in CR at an urban CR program in the United States. Participants were English speaking, at least 18 years of age, participated in the program between May 22, 2020, and May 21, 2022, and downloaded the CR mobile app. Mobile app use was quantified by number of exercise logs, vitals logs, and education material views. The primary outcome was change in functional capacity, measured by change in 6-minute walk distance (6MWD) from enrollment to completion. The secondary outcome was change in BP from enrollment to completion. We estimated associations using multivariable linear or logistic regression models adjusted for age, sex, race, ethnicity, socioeconomic status by ZIP code, insurance, and primary diagnosis for CR referral.</p><p><strong>Results: </strong>A total of 107 participants (mean age 62.9, SD 13.02 years; 90/107, 84.1% male; and 57/105, 53.3% self-declared as White Caucasian) used the mobile app and completed the CR program. Participants had a mean 64.0 (SD 54.1) meter increase in 6MWD between enrollment and completion (P<.001). From enrollment to completion, participants with an elevated BP at baseline (≥130/80 mmHg) experienced a significant decrease in BP (systolic BP -11.5 mmHg; P=.002 and diastolic BP -7.7 mmHg; P=.003). We found no significant association between total app interactions and change in 6MWD (coefficient -0.03, 95% CI -0.1 to 0.07; P=.59) or change in BP (systolic coefficient 0.002, 95% CI -0.03 to 0.03; P=.87 and diastolic coefficient -0.005, 95% CI -0.03 to 0.02; P=.65). There was no significant association between total exercise logs and change in 6MWD (coefficient 0.1, 95% CI -0.3 to 0.4; P=.57) or total BP logs and change in BP (systolic coefficient -0.02, 95% CI -0.1 to 0.06; P=.63 and diastolic coefficient -0.02, 95% CI -0.09 to 0.04; P=.50). There was no significant association between total app interactions and completion of CR (adjusted odds ratio 1.00, 95% CI 0.99-1.01; P=.44).</p><p><strong>Conclusions: </strong>CR mobile app use as part of an in-person, hybrid, or telehealth CR program was not associated with greater improvement in functional capacity or BP or with program completion.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e44433"},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10227697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9555396","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":"Data Quality Degradation on Prediction Models Generated From Continuous Activity and Heart Rate Monitoring: Exploratory Analysis Using Simulation.","authors":"Jason Hearn,&nbsp;Jef Van den Eynde,&nbsp;Bhargava Chinni,&nbsp;Ari Cedars,&nbsp;Danielle Gottlieb Sen,&nbsp;Shelby Kutty,&nbsp;Cedric Manlhiot","doi":"10.2196/40524","DOIUrl":"https://doi.org/10.2196/40524","url":null,"abstract":"<p><strong>Background: </strong>Limited data accuracy is often cited as a reason for caution in the integration of physiological data obtained from consumer-oriented wearable devices in care management pathways. The effect of decreasing accuracy on predictive models generated from these data has not been previously investigated.</p><p><strong>Objective: </strong>The aim of this study is to simulate the effect of data degradation on the reliability of prediction models generated from those data and thus determine the extent to which lower device accuracy might or might not limit their use in clinical settings.</p><p><strong>Methods: </strong>Using the Multilevel Monitoring of Activity and Sleep in Healthy People data set, which includes continuous free-living step count and heart rate data from 21 healthy volunteers, we trained a random forest model to predict cardiac competence. Model performance in 75 perturbed data sets with increasing missingness, noisiness, bias, and a combination of all 3 perturbations was compared to model performance for the unperturbed data set.</p><p><strong>Results: </strong>The unperturbed data set achieved a mean root mean square error (RMSE) of 0.079 (SD 0.001) in predicting cardiac competence index. For all types of perturbations, RMSE remained stable up to 20%-30% perturbation. Above this level, RMSE started increasing and reached the point at which the model was no longer predictive at 80% for noise, 50% for missingness, and 35% for the combination of all perturbations. Introducing systematic bias in the underlying data had no effect on RMSE.</p><p><strong>Conclusions: </strong>In this proof-of-concept study, the performance of predictive models for cardiac competence generated from continuously acquired physiological data was relatively stable with declining quality of the source data. As such, lower accuracy of consumer-oriented wearable devices might not be an absolute contraindication for their use in clinical prediction models.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e40524"},"PeriodicalIF":0.0,"publicationDate":"2023-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10193221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9860679","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 Artificial Intelligence-Based Electrocardiography Analysis for the Prediction of Obstructive Coronary Artery Disease in Patients With Stable Angina: Validation Study.","authors":"Jiesuck Park,&nbsp;Yeonyee Yoon,&nbsp;Youngjin Cho,&nbsp;Joonghee Kim","doi":"10.2196/44791","DOIUrl":"https://doi.org/10.2196/44791","url":null,"abstract":"<p><strong>Background: </strong>Despite accumulating research on artificial intelligence-based electrocardiography (ECG) algorithms for predicting acute coronary syndrome (ACS), their application in stable angina is not well evaluated.</p><p><strong>Objective: </strong>We evaluated the utility of an existing artificial intelligence-based quantitative electrocardiography (QCG) analyzer in stable angina and developed a new ECG biomarker more suitable for stable angina.</p><p><strong>Methods: </strong>This single-center study comprised consecutive patients with stable angina. The independent and incremental value of QCG scores for coronary artery disease (CAD)-related conditions (ACS, myocardial injury, critical status, ST-elevation myocardial infarction, and left ventricular dysfunction) for predicting obstructive CAD confirmed by invasive angiography was examined. Additionally, ECG signals extracted by the QCG analyzer were used as input to develop a new QCG score.</p><p><strong>Results: </strong>Among 723 patients with stable angina (median age 68 years; male: 470/723, 65%), 497 (69%) had obstructive CAD. QCG scores for ACS and myocardial injury were independently associated with obstructive CAD (odds ratio [OR] 1.09, 95% CI 1.03-1.17 and OR 1.08, 95% CI 1.02-1.16 per 10-point increase, respectively) but did not significantly improve prediction performance compared to clinical features. However, our new QCG score demonstrated better prediction performance for obstructive CAD (area under the receiver operating characteristic curve 0.802) than the original QCG scores, with incremental predictive value in combination with clinical features (area under the receiver operating characteristic curve 0.827 vs 0.730; P<.001).</p><p><strong>Conclusions: </strong>QCG scores developed for acute conditions show limited performance in identifying obstructive CAD in stable angina. However, improvement in the QCG analyzer, through training on comprehensive ECG signals in patients with stable angina, is feasible.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e44791"},"PeriodicalIF":0.0,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10189614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9477097","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":"Accuracy of Artificial Intelligence-Based Automated Quantitative Coronary Angiography Compared to Intravascular Ultrasound: Retrospective Cohort Study.","authors":"In Tae Moon,&nbsp;Sun-Hwa Kim,&nbsp;Jung Yeon Chin,&nbsp;Sung Hun Park,&nbsp;Chang-Hwan Yoon,&nbsp;Tae-Jin Youn,&nbsp;In-Ho Chae,&nbsp;Si-Hyuck Kang","doi":"10.2196/45299","DOIUrl":"https://doi.org/10.2196/45299","url":null,"abstract":"<p><strong>Background: </strong>An accurate quantitative analysis of coronary artery stenotic lesions is essential to make optimal clinical decisions. Recent advances in computer vision and machine learning technology have enabled the automated analysis of coronary angiography.</p><p><strong>Objective: </strong>The aim of this paper is to validate the performance of artificial intelligence-based quantitative coronary angiography (AI-QCA) in comparison with that of intravascular ultrasound (IVUS).</p><p><strong>Methods: </strong>This retrospective study included patients who underwent IVUS-guided coronary intervention at a single tertiary center in Korea. Proximal and distal reference areas, minimal luminal area, percent plaque burden, and lesion length were measured by AI-QCA and human experts using IVUS. First, fully automated QCA analysis was compared with IVUS analysis. Next, we adjusted the proximal and distal margins of AI-QCA to avoid geographic mismatch. Scatter plots, Pearson correlation coefficients, and Bland-Altman were used to analyze the data.</p><p><strong>Results: </strong>A total of 54 significant lesions were analyzed in 47 patients. The proximal and distal reference areas, as well as the minimal luminal area, showed moderate to strong correlation between the 2 modalities (correlation coefficients of 0.57, 0.80, and 0.52, respectively; P<.001). The correlation was weaker for percent area stenosis and lesion length, although statistically significant (correlation coefficients of 0.29 and 0.33, respectively). AI-QCA tended to measure reference vessel areas smaller and lesion lengths shorter than IVUS did. Systemic proportional bias was not observed in Bland-Altman plots. The biggest cause of bias originated from the geographic mismatch of AI-QCA with IVUS. Discrepancies in the proximal or distal lesion margins were observed between the 2 modalities, which were more frequent at the distal margins. After the adjustment of proximal or distal margins, there was a stronger correlation of proximal and distal reference areas between AI-QCA and IVUS (correlation coefficients of 0.70 and 0.83, respectively).</p><p><strong>Conclusions: </strong>AI-QCA showed a moderate to strong correlation compared with IVUS in analyzing coronary lesions with significant stenosis. The main discrepancy was in the perception of the distal margins by AI-QCA, and the correction of margins improved the correlation coefficients. We believe that this novel tool could provide confidence to treating physicians and help in making optimal clinical decisions.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e45299"},"PeriodicalIF":0.0,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10173041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9820286","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":"Cardio4Health Study, a Cardiac Telerehabilitation Pilot Program Aimed at Patients After an Ischemic Event: Cross-sectional Study.","authors":"Margarita Calvo-López,&nbsp;Raquel Arranz Tolós,&nbsp;Josefa Marin Expósito,&nbsp;Domenico Gruosso,&nbsp;Rut Andrea,&nbsp;Mercè Roque,&nbsp;Carles Falces,&nbsp;Gemma Yago,&nbsp;Judith Saura Araguas,&nbsp;Nuria Pastor,&nbsp;Marta Sitges,&nbsp;Maria Sanz-de la Garza","doi":"10.2196/44179","DOIUrl":"https://doi.org/10.2196/44179","url":null,"abstract":"<p><strong>Background: </strong>Center-based cardiac rehabilitation programs (CRPs) reduce morbidity and mortality after an ischemic cardiac event; however, they are widely underused. Home-based CRP has emerged as an alternative to improve patient adherence; however, its safety and efficacy remain unclear, especially for older patients and female patients.</p><p><strong>Objective: </strong>This study aimed to develop a holistic home-based CRP for patients with ischemic heart disease and evaluate its safety and impact on functional capacity, adherence to a healthy lifestyle, and quality of life.</p><p><strong>Methods: </strong>The 8-week home-based CRP included patients of both sexes, with no age limit, who had overcome an acute myocardial infarction in the previous 3 months, had a left ventricular ejection fraction of ≥40%, and had access to a tablet or mobile device. The CRP was developed using a dedicated platform designed explicitly for this purpose and included 3 weekly exercise sessions combining tailored aerobic and strength training and 2 weekly educational session focused on lifestyle habits, therapeutic adherence, and patient empowerment.</p><p><strong>Results: </strong>We initially included 62 patients, of whom 1 was excluded for presenting with ventricular arrhythmias during the initial stress test, 5 were excluded because of incompatibility, and 6 dropped out because of a technological barrier. Ultimately, 50 patients completed the program: 85% (42/50) were male, with a mean age of 58.9 (SD 10.3) years, a mean left ventricular ejection fraction of 52.1% (SD 6.72%), and 25 (50%) New York Heart Association functional class I and 25 (50%) New York Heart Association II-III. The CRP significantly improved functional capacity (+1.6 metabolic equivalent tasks), muscle strength (arm curl test +15.5% and sit-to-stand test +19.7%), weekly training volume (+803 metabolic equivalent tasks), adherence to the Mediterranean diet, emotional state (anxiety), and quality of life. No major complications occurred, and adherence was excellent (>80%) in both the exercise and educational sessions. In the subgroup analysis, CRP showed equivalent beneficial effects irrespective of sex and age. In addition, patient preferences for CRP approaches were equally distributed, with one-third (14/50, 29%) of the patients preferring a face-to-face CRP, one-third (17/50, 34%) preferring a telematic CRP, and one-third (18/50, 37%) preferring a hybrid approach. Regarding CRP duration, 63% (31/50) of the patients considered it adequate, whereas the remaining 37% (19/50) preferred a longer program.</p><p><strong>Conclusions: </strong>A holistic telematic CRP dedicated to patients after an ischemic cardiac event, irrespective of sex and age, is safe and, in our population, has achieved positive results in improving maximal aerobic capacity, weekly training volume, muscle strength, quality of life, compliance with diet, and anxiety symptoms. The preference for a center- or h","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e44179"},"PeriodicalIF":0.0,"publicationDate":"2023-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10167584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10299135","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":"Engagement in Self-measured Blood Pressure Monitoring Among Medically Underresourced Participants (the Reach Out Trial): Digital Framework Qualitative Study.","authors":"Abby Katherine Hellem,&nbsp;Candace Whitfield,&nbsp;Amanda Casetti,&nbsp;Maria Cielito Robles,&nbsp;Mackenzie Dinh,&nbsp;William Meurer,&nbsp;Lesli Skolarus","doi":"10.2196/38900","DOIUrl":"https://doi.org/10.2196/38900","url":null,"abstract":"<p><strong>Background: </strong>Mobile health (mHealth) interventions serve as a scalable opportunity to engage people with hypertension in self-measured blood pressure (SMBP) monitoring, an evidence-based approach to lowering blood pressure (BP) and improving BP control. Reach Out is an SMS text messaging-based SMBP mHealth trial that aims to reduce BP among hypertensive patients recruited from the emergency department of a safety net hospital in a low-income, predominately Black city.</p><p><strong>Objective: </strong>As the benefits of Reach Out are predicated on participants' engagement with the intervention, we sought to understand participants' determinants of engagement via prompted SMBP with personalized feedback (SMBP+feedback).</p><p><strong>Methods: </strong>We conducted semistructured telephone interviews based on the digital behavior change interventions framework. Participants were purposively sampled from 3 engagement categories: high engagers (≥80% response to SMBP prompts), low engagers (≤20% response to BP prompts), and early enders (participants who withdrew from the trial).</p><p><strong>Results: </strong>We conducted interviews with 13 participants, of whom 7 (54%) were Black, with a mean age of 53.6 (SD 13.25) years. Early enders were less likely to be diagnosed with hypertension prior to Reach Out, less likely to have a primary care provider, and less likely to be taking antihypertensive medications than their counterparts. Overall, participants liked the SMS text messaging design of the intervention, including the SMBP+feedback. Several participants across all levels of engagement expressed interest in and identified the benefit of enrolling in the intervention with a partner of their choice. High engagers expressed the greatest understanding of the intervention, the least number of health-related social needs, and the greatest social support to engage in SMBP. Low engagers and early enders shared a mixed understanding of the intervention and less social support compared to high engagers. Participation decreased as social needs increased, with early enders sharing the greatest amount of resource insecurity apart from a notable exception of a high engager with high health-related social needs.</p><p><strong>Conclusions: </strong>Prompted SMBP+feedback was perceived favorably by all participants. To enhance SMBP engagement, future studies could consider greater support in the initiation of SMBP, evaluating and addressing participants' unmet health-related social needs, as well as strategies to cultivate social norms.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e38900"},"PeriodicalIF":0.0,"publicationDate":"2023-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10131992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9725279","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":"Implementation and User Evaluation of an eHealth Technology Platform Supporting Patients With Cardiovascular Disease in Managing Their Health After a Cardiac Event: Mixed Methods Study.","authors":"Britt E Bente,&nbsp;Jobke Wentzel,&nbsp;Celina Schepers,&nbsp;Linda D Breeman,&nbsp;Veronica R Janssen,&nbsp;Marcel E Pieterse,&nbsp;Andrea W M Evers,&nbsp;Lisette van Gemert-Pijnen","doi":"10.2196/43781","DOIUrl":"https://doi.org/10.2196/43781","url":null,"abstract":"Background eHealth technology can help patients with cardiovascular disease adopt and maintain a healthy lifestyle by supporting self-management and offering guidance, coaching, and tailored information. However, to support patients over time, eHealth needs to blend in with their needs, treatment, and daily lives. Just as needs can differ between patients, needs can change within patients over time. To better adapt technology features to patients’ needs, it is necessary to account for these changes in needs and contexts of use. Objective This study aimed to identify and monitor patients’ needs for support from a web-based health management platform and how these needs change over time. It aimed to answer the following research questions: “How do novice and more advanced users experience an online health management platform?” “What user expectations support or hinder the adoption of an online health management platform, from a user perspective?” and “How does actual usage relate to user experiences and adoption?” Methods A mixed methods design was adopted. The first method involved 2 rounds of usability testing, followed by interviews, with 10 patients at 0 months (round 1) and 12 patients at 6 months (round 2). In the second method, log data were collected to describe the actual platform use. Results After starting cardiac rehabilitation, the platform was used frequently. The patients mentioned that they need to have an incentive, set goals, self-monitor their health data, and feel empowered by the platform. However, soon after the rehabilitation program stopped, use of the platform declined or patients even quit because of the lack of continued tailored or personalized advice. The reward system motivated them to log data, but most participants indicated that being healthy should be the main focus, not receiving gifts. A web-based platform is flexible, accessible, and does not have any obligations; however, it should be implemented as an addition to regular care. Conclusions Although use of the platform declined in the longer term, patients quitting the technology did not directly indicate that the technology was not functioning well or that patients no longer focused on achieving their values. The key to success should not be user adherence to a platform but adherence to healthy lifestyle habits. Therefore, the implementation of eHealth should include the transition to a stage where patients might no longer need support from a technology platform to be independently and sustainably adherent to their healthy lifestyle habits. This emphasizes the importance of conducting multi-iterative evaluations to continuously monitor whether and how patients’ needs and contexts of use change over time. Future research should focus on how this transition can be identified and monitored and how these insights can inform the design and implementation of the technology.","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e43781"},"PeriodicalIF":0.0,"publicationDate":"2023-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10131764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9710119","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 Smartwatch System for Continuous Monitoring of Atrial Fibrillation in Older Adults After Stroke or Transient Ischemic Attack: Application Design Study.","authors":"Dong Han,&nbsp;Eric Y Ding,&nbsp;Chaeho Cho,&nbsp;Haewook Jung,&nbsp;Emily L Dickson,&nbsp;Fahimeh Mohagheghian,&nbsp;Andrew G Peitzsch,&nbsp;Danielle DiMezza,&nbsp;Khanh-Van Tran,&nbsp;David D McManus,&nbsp;Ki H Chon","doi":"10.2196/41691","DOIUrl":"https://doi.org/10.2196/41691","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of atrial fibrillation (AF) increases with age and can lead to stroke. Therefore, older adults may benefit the most from AF screening. However, older adult populations tend to lag more than younger groups in the adoption of, and comfort with, the use of mobile health (mHealth) apps. Furthermore, although mobile apps that can detect AF are available to the public, most are designed for intermittent AF detection and for younger users. No app designed for long-term AF monitoring has released detailed system design specifications that can handle large data collections, especially in this age group.</p><p><strong>Objective: </strong>This study aimed to design an innovative smartwatch-based AF monitoring mHealth solution in collaboration with older adult participants and clinicians.</p><p><strong>Methods: </strong>The Pulsewatch system is designed to link smartwatches and smartphone apps, a website for data verification, and user data organization on a cloud server. The smartwatch in the Pulsewatch system is designed to continuously monitor the pulse rate with embedded AF detection algorithms, and the smartphone in the Pulsewatch system is designed to serve as the data-transferring hub to the cloud storage server.</p><p><strong>Results: </strong>We implemented the Pulsewatch system based on the functionality that patients and caregivers recommended. The user interfaces of the smartwatch and smartphone apps were specifically designed for older adults at risk for AF. We improved our Pulsewatch system based on feedback from focus groups consisting of patients with stroke and clinicians. The Pulsewatch system was used by the intervention group for up to 6 weeks in the 2 phases of our randomized clinical trial. At the conclusion of phase 1, 90 trial participants who had used the Pulsewatch app and smartwatch for 14 days completed a System Usability Scale to assess the usability of the Pulsewatch system; of 88 participants, 56 (64%) endorsed that the smartwatch app is \"easy to use.\" For phases 1 and 2 of the study, we collected 9224.4 hours of smartwatch recordings from the participants. The longest recording streak in phase 2 was 21 days of consecutive recordings out of the 30 days of data collection.</p><p><strong>Conclusions: </strong>This is one of the first studies to provide a detailed design for a smartphone-smartwatch dyad for ambulatory AF monitoring. In this paper, we report on the system's usability and opportunities to increase the acceptability of mHealth solutions among older patients with cognitive impairment.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov NCT03761394; https://www.clinicaltrials.gov/ct2/show/NCT03761394.</p><p><strong>International registered report identifier (irrid): </strong>RR2-10.1016/j.cvdhj.2021.07.002.</p>","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e41691"},"PeriodicalIF":0.0,"publicationDate":"2023-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9972205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10803585","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":"Remotely Delivered Cardiac Rehabilitation Exercise for Coronary Heart Disease: Nonrandomized Feasibility Study.","authors":"Oonagh M Giggins,&nbsp;Julie Doyle,&nbsp;Suzanne Smith,&nbsp;Grainne Vavasour,&nbsp;Orla Moran,&nbsp;Shane Gavin,&nbsp;Nisanth Sojan,&nbsp;Gordon Boyle","doi":"10.2196/40283","DOIUrl":"https://doi.org/10.2196/40283","url":null,"abstract":"<p><strong>Background: </strong>Exercise-based cardiac rehabilitation (CR) is recommended for coronary heart disease (CHD). However, poor uptake of and poor adherence to CR exercise programs have been reported globally. Delivering CR exercise classes remotely may remove some of the barriers associated with traditional hospital- or center-based CR.</p><p><strong>Objective: </strong>We have developed a bespoke platform, Eastern Corridor Medical Engineering Centre-Cardiac Rehabilitation (ECME-CR), to support remotely delivered CR exercise. This pilot trial sought to test the ECME-CR platform and examine the efficacy and feasibility of a remote CR exercise program compared to a traditional center-based program.</p><p><strong>Methods: </strong>In all, 21 participants with CHD were recruited and assigned to either the intervention or control group. Both groups performed the same 8-week exercise program. Participants in the intervention group took part in web-based exercise classes and used the ECME-CR platform during the intervention period, whereas participants in the control group attended in-person classes. Outcomes were assessed at baseline and following the 8-week intervention period. The primary outcome measure was exercise capacity, assessed using a 6-minute walk test (6MWT). Secondary outcomes included measurement of grip strength, self-reported quality of life, heart rate, blood pressure, and body composition. A series of mixed between-within subjects ANOVA were conducted to examine the mean differences in study outcomes between and within groups. Participant adherence to the exercise program was also analyzed.</p><p><strong>Results: </strong>In all, 8 participants (male: n=5; age: mean 69.7, SD 7.2 years; height: mean 163.9, SD 5.4 cm; weight: mean 81.6, SD 14.1 kg) in the intervention group and 9 participants (male: n=9; age: mean 69.8, SD 8.2 years; height: mean 173.8, SD 5.2 cm; weight: mean 94.4, SD 18.0 kg) in the control group completed the exercise program. Although improvements in 6MWT distance were observed from baseline to follow-up in both the intervention (mean 490.1, SD 80.2 m to mean 504.5, SD 93.7 m) and control (mean 510.2, SD 48.3 m to mean 520.6, SD 49.4 m) group, no significant interaction effect (F_1,14=.026; P=.87) nor effect for time (F_1,14=2.51; P=.14) were observed. No significant effects emerged for any of the other secondary end points (all P>.0275). Adherence to the exercise program was high in both the intervention (14.25/16, 89.1%) and control (14.33/16, 89.6%) group. No adverse events or safety issues were reported in either group during the study.</p><p><strong>Conclusions: </strong>This pilot trial did not show evidence of significant positive effect for either the remotely delivered or center-based program. The 6MWT may not have been sufficiently sensitive to identify a change in this cohort of participants with stable CHD. This trial does provide evidence that remote CR exercise, supporte","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e40283"},"PeriodicalIF":0.0,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9960022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10774144","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":"The Impact and Perception of England's Web-Based Heart Age Test of Cardiovascular Disease Risk: Mixed Methods Study.","authors":"Victoria Riley,&nbsp;Christopher Gidlow,&nbsp;Sophia Fedorowicz,&nbsp;Catherine Lagord,&nbsp;Katherine Thompson,&nbsp;Joshua Woolner,&nbsp;Rosie Taylor,&nbsp;Jade Clark,&nbsp;Andrew Lloyd-Harris","doi":"10.2196/39097","DOIUrl":"https://doi.org/10.2196/39097","url":null,"abstract":"<p><strong>Background: </strong>It is well documented that individuals struggle to understand cardiovascular disease (CVD) percentage risk scores, which led to the development of heart age as a means of communicating risk. Developed for clinical use, its application in raising public awareness of heart health as part of a self-directed digital test has not been considered previously.</p><p><strong>Objective: </strong>This study aimed to understand who accesses England's heart age test (HAT) and its effect on user perception, knowledge, and understanding of CVD risk; future behavior intentions; and potential engagement with primary care services.</p><p><strong>Methods: </strong>There were 3 sources of data: routinely gathered data on all individuals accessing the HAT (February 2015 to June 2020); web-based survey, distributed between January 2021 and March 2021; and interviews with a subsample of survey respondents (February 2021 to March 2021). Data were used to describe the test user population and explore knowledge and understanding of CVD risk, confidence in interpreting and controlling CVD risk, and effect on future behavior intentions and potential engagement with primary care. Interviews were analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>Between February 2015 and June 2020, the HAT was completed approximately 5 million times, with more completions by men (2,682,544/4,898,532, 54.76%), those aged between 50 to 59 years (1,334,195/4,898,532, 27.24%), those from White ethnic background (3,972,293/4,898,532, 81.09%), and those living in the least deprived 20% of areas (707,747/4,898,532, 14.45%). The study concluded with 819 survey responses and 33 semistructured interviews. Participants stated that they understood the meaning of high estimated heart age and self-reported at least some improvement in the understanding and confidence in understanding and controlling CVD risk. Negative emotional responses were provoked among users when estimated heart age did not equate to their previous risk perceptions. The limited information needed to complete it or the production of a result when physiological risk factor information was missing (ie, blood pressure and cholesterol level) led some users to question the credibility of the test. However, most participants who were interviewed mentioned that they would recommend or had already recommended the test to others, would use it again in the future, and would be more likely to take up the offer of a National Health Service Health Check and self-reported that they had made or intended to make changes to their health behavior or felt encouraged to continue to make changes to their health behavior.</p><p><strong>Conclusions: </strong>England's web-based HAT has engaged large number of people in their heart health. Improvements to England's HAT, noted in this paper, may enhance user satisfaction and prevent confusion. Future studies to understand the long-term benefit of the te","PeriodicalId":14706,"journal":{"name":"JMIR Cardio","volume":"7 ","pages":"e39097"},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9983813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9082156","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}