bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of a wearable patch sensor for continuous activity and posture tracking to assess risk of early infection after transcatheter aortic valve replacement
Authors: Maier O , Dollmeyer W , Nieto N , Wolff G , Zeus T , Veulemans V , Kelm M , Jung C 
Published: November 2023

Abstract

Background
Early infections after transcatheter aortic valve replacement (TAVR) represent one of the most common risk factors for non-cardiac 30-day mortality. Several wearable devices have been developed to measure vital signs and physical activity in real time while allowing full mobilization of the patient. However, their use has not been evaluated in a clinical setting with patients undergoing TAVR yet.

Purpose
We aimed to evaluate the feasibility of wearable patch sensors in assessing vital signs and daily activity before and after TAVR to predict an increased risk of early infections following TAVR.

Methods
Patients at high risk for infection undergoing transfemoral TAVR under local anesthesia were enrolled between September 2022 and January 2023. Postprocedural early infections were assessed, defined as C-reactive protein rise within 5 days after the procedure inducing antibiotic treatment. Vital signs (heart rate, respiratory rate, single-lead ECG) and activity (steps, posture) were monitored by a wearable patch sensor two days before (pre-TAVR) and two days after TAVR (post-TAVR).

Results
54 patients completed 5 days of in-hospital monitoring with wearable patch sensors. The mean age was 80.3+5.2 years, 31 patients (57.4%) were male. Early infections occurred in 8 of 54 (14.8%) high-risk patients, of whom one was a urinary tract, one a pulmonary, and two access site-related etiology. Four infections remained with unknown focus.
Respiratory rate was generally higher in patients developing an early infection after TAVR in both time periods, before (early infection 22±3 vs. no infection 18±2 bpm; p=0.001) and after TAVR (early infection 24±3 vs. no infection 19±3 bpm; p&lt;0.001).
Early infections were more prevalent in patients who showed less activity in the two days before TAVR regarding lower step count (early infection 242±360 vs. no infection 515±566; p=0.048) and high percentage of lying position during the whole day (early infection 89±12% vs. no infection 64±23%; p=0.071). Two days after TAVR, there were no significant differences in activity levels between both cohorts. Physical activity was reduced in both groups compared to the two days before TAVR, resulting in a reduced number of steps (pre-TAVR 473±546 vs. post-TAVR 267±434; p=0.039) and more daytime spent in lying position (pre-TAVR 57±19% vs. post-TAVR 73±24%; p&lt;0.0001).

Conclusion
Wearable patch sensors are feasible to track vital signs and physical activity during hospital stay with promising opportunity for improving clinical management in TAVR patients. Early infections after TAVR are associated with decreased preprocedural mobility in high-risk patients. Therefore, these patients may be prematurely detected using wireless respiratory rate monitoring and infections prevented by intensified physiotherapy.
The R-Wave amplitude in V1 on baseline ECG correlates with the occurrence of high-degree atrioventricular block following left bundle branch block after transcatheter aortic valve replacement
Authors: Rachamim E R , Yagel O , Belhassen B , Planer D , Amir O , Elbaz-Greener G 
Published: November 2023

Abstract

Aims
Several procedural and ECG parameters have been associated with the occurrence of high-degree atrioventricular block (AVB) requiring permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). We hereunder sought to assess if the baseline R-wave amplitude in V1 ECG-lead of patients with normal QRS duration undergoing TAVR is associated with a higher patient’s risk for developing high-degree AVB following left bundle branch block (LBBB).

Methods and Results
In this retrospective single-center study in 720 consecutive patients who underwent TAVR, 141 (19.6%) patients with normal QRS duration developed a new LBBB after TAVR. The 24 (17%) patients who underwent PPI for reasons other than high-degree AVB were excluded from further analysis. In the remaining 117 study patients, 14 (12%) developed high-degree AVB requiring PPI (Group 1) while the remaining 103 (88%) patients did not (Group 2).
There were no significant differences in baseline demographic or procedural characteristics nor in PR interval, QRS duration and QRS axis between these 2 groups. The incidence of left anterior hemiblock was higher in Group 1 (3 of 14, 21.4%) than in Group 2 (9 of 103, 8.7%) but the difference was not statistically significant (p=0.156).
The R-wave amplitude in V1 was smaller in Group 1 than in Group 2 (0.029±0.04mV vs. 0.11±0.14mV, p=0.0316). In the receiver operating characteristics analysis, the cutoff for R-wave amplitude pre-TAVR was 0.03mV, area under the curve=0.7219, (p=0.0002).

Conclusion
The R-wave amplitude in lead V1 during baseline ECG in patients with normal QRS duration may predict the occurrence of high-degree AVB following new LBBB after TAVR.Figure 1.ROC AnalysisFigure 2.Representative case
Physician-to-physician universal electronic consultation program (e-consultation) in a Cardiology Department: Impact on elapsed time to cardiology care and cardiovascular outcomes
Authors: Gonzalez-Juanatey J R , Garcia Vega D , Iglesias-Alvarez D , Garcia-Acuna J M , Portela-Romero M , Rey-Aldana D , Cinza-Sanjurjo S 
Published: November 2023

Abstract

Background
Many health systems have initiated electronic consultation programs, although little is known about their impact on accessibility, safety and satisfaction. In 2019, we began to analyse our model1. The first results showed that it was an efficient model2 and safe, with a reduction in emergency department visits, mortality and hospitalization3. In the last 3 years we have live a lot of changes. In one hand, all models need a continuous evaluation of their results, and confirm that the outcomes are similar to the beginning. In the other hand, we lived a world pandemic and our health models have changed in these years.
In an e-consultation, the Primary Care Physician, who referred the patient, uses the shared electronic records and the Cardiologist who answer also uses the same electronic records to review all the clinical information and to send an answer. The Cardiologist can resolve directly the referral or to make an appointment with the patient in person in cases where it is necessary4.

Purpose
The aim of this study is to assess the clinical impact of the implementation of a model of ambulatory care that includes an initial electronic consultation (e-consultation), comparing it with a face-to-face single act model.

Methods
We selected patients with at least one visit to the Cardiology Service between 2010 and 2021. Using an interrupted time series regression model, we analysed the impact of incorporating the e-consultation into the healthcare model (started in 2013), evaluating: waiting time for care, hospitalizations and mortality in the first year.

Results
We analysed 61,306 patients: 66,0% attended by incorporating the e-consultation and 34,0% in the one-time face-to-face consultation model. The delay time for care in the e-consultation model (mean [SD]: 8.4 days [9.1]) was shorter than in the face-to-face model (mean [SD]: 50.6 days [72.2]), p &lt; 0.001. The regression model for interrupted time series showed that the incorporation of e-consultation contributed a very important decrease in the delay of attention, remaining around 8 days, although with slight oscillations. The e-consultation model represented a reduction in hospitalizations (iRR [95%CI]: 0.635 [0.635-0.641]), cardiovascular hospitalizations (iRR [95%CI]: 0.857 [0.846-0.868]), Figure 1, mortality (iRR [95%CI]: 0.936 [0.923-0.951]) and cardiovascular mortality (iRR [95%CI]: 0.979 [0.964-0.996]), Figure 2.

Conclusions
An outpatient care program that includes an e-consultation has shown to reduce waiting times significantly and is a safe model with a lower rate of hospitalizations and mortality in the first year.Figure 1Figure 2
Remote heart rhythm assessment using smartphone-based photoplethysmography in primary care to detect undiagnosed atrial fibrillation in patients with chronic obstructive pulmonary disease
Authors: Khan M , Evens S E , Childe S , Hickling C , Abbott L 
Published: November 2023

Abstract

Introduction
Atrial fibrillation (AF) is the most common cardiac arrhythmia leading to healthcare consultation in primary care. The increased risk to develop AF when suffering from chronic obstructive pulmonary disease (COPD) has been extensively described in literature. However, it remains challenging to perform in-office, opportunistic screening for AF in COPD patients during daily routine using pulse checks or single-spot ECGs due to the increasing pressure on primary care.

Purpose
The goal of this study was to evaluate the accuracy and effectiveness of a smartphone-based photoplethysmography (PPG) technology to enable remote heart rhythm monitoring and new AF detection in patients with COPD.

Methods
Diagnosed COPD patients, without an established AF diagnosis, were identified via the electronic medical record. Patients who fulfilled these criteria and hadn’t had an ECG in the past two years were selected to take part in this study. Other inclusion criteria were access to a smartphone and the physical ability to place their fingertip on a smartphone camera. Eligible patients were contacted via text message and after providing informed consent, the study team invited them to activate a 7-day invitation code to access a medically certified smartphone application. Patients were instructed to perform PPG measurements twice daily and when experiencing symptoms. Those with possible AF based on the PPG recordings were invited for a confirmatory ECG to establish the AF diagnosis.

Results
In total, 90/270 eligible patients (30%) provided informed consent and activated the on-demand invitation code to remotely monitor their heart rhythm using a PPG-based smartphone application. Of these, 50 (55.6%) were female and the median age was 68 years old (IQR: 59-74). The newly discovered AF detection yield was 5.6% (5/90).
In-office 12-lead ECG confirmed AF in 3/5 patients (60%). The remaining patients, with a negative in-office 12-lead ECG, were invited for long-term intermittent ECG monitoring using a handheld ECG device (Zenicor). One patient accepted the proposal and paroxysmal AF was confirmed after 4 weeks of intermittent, symptom-triggered ECG monitoring. The remaining patient was not willing to perform long-term monitoring after the negative in-office ECG. However, this patient was diagnosed with paroxysmal AF as well after presentation at the emergency department while suffering from a transient ischemic attack three months after the initial AF detection using PPG technology.

Conclusion
Remote heart rhythm assessment using smartphone-based PPG in primary care within a COPD population was feasible and resulted in the detection of newly diagnosed AF in COPD patients. All patients identified with possible AF based on PPG monitoring were confirmed and diagnosed via ECG which enabled the initiation of guideline-based AF management.
Medication intake reminders via a smartphone app improve real-world adherence to oral anticoagulation in atrial fibrillation patients
Authors: Knaepen L , Delesie M , Theunis R , Gorissen P , Vijgen J , Dendale P , Desteghe L , Heidbuchel H 
Published: November 2023

Abstract

Introduction
Treatment with oral anticoagulation (OAC) is one of the main pillars in managing atrial fibrillation (AF). Education and intake monitoring are recommended to improve therapy adherence to OAC. Over the past few years, the importance of smart devices has increased, opening up new potential for patient education and better patient follow-up.

Purpose
We wanted to evaluate the usage of a medication module of an in-house developed application, AF-EduApp, and its effect on patients’ therapy adherence to OAC.

Methods
The AF-EduApp multicenter study included 152 AF patients. The educational AF-EduApp contains, besides other modules, a medication module with the possibility to add a medication list. Patients also had the possibility to configure pill intake reminders which they could easily tick off. Adherence was calculated as the proportion of days that the medication was correctly taken, as indicated by the patient. This was compared with adherence measured by the Electronic Medication Event Monitoring System (MEMS, Aardex Group, Liège), which formed the primary outcome of this study. The MEMS cap registered the date and time of bottle opening and was used at baseline and after 12 months, each time for a monitoring period of 3 months (M1 respectively M2). Regimen adherence was defined as the proportion of days with the correct number of openings as recorded by MEMS.

Results
The 152 patients (Age: 68.8 ±6.7 years; Time since AF diagnosis: 5.1 ±6.6 years) used the application on 130.1 ±144.7 days during a mean follow-up of 386.8 ±108.1 days. A total of 137 patients were on OAC, of whom 87 patients set a reminder for the OAC in their medication list. If based on checking off the reminder, patients had a median therapy adherence of only 5.6% (IQR: 0.2-64.3%). This contrasts with a high regimen adherence based on MEMS: in 84 patients who completed both monitoring periods, adherence was 94.5 ±7.0% at M1 and 94.1 ±6.6% at M2 (p=0.266 between M1 and M2). At M1, there was already a trend towards a significant difference in MEMS regimen adherence between patients who did or did not set a reminder (96.3 ±4.8% vs 93.1 ±8.0%, n=84; p=0.067). At M2, patients who set a reminder took their medication significantly better than those who did not (96.2 ±5.3% vs 92.6 ±7.1%; p=0.048) (Fig 1).

Conclusion
The medication module was used by most of the patients, and 63.5% installed an intake reminder for at least their OAC therapy. However, checking off reminders is rarely done and cannot be used to judge adherence. On the other hand, patients who installed a reminder had a significantly higher real-world regimen adherence for OAC compared to patients who did not set a reminder. Medication intake reminders can contribute to improving adherence to OAC therapy.MEMS based real-world regimen adherence
Smartphone for heart sound measurement in hospital: which factors affect heart sound quality?
Authors: Luo H , Li Y , Prinzen F 
Published: November 2023

Abstract

Background
Smartphone has recently been utilized to measure heart sounds in general population, but not in hospitalized patients.

Purpose
To explore the factors affecting the quality of heart sounds collected from the patients using smartphone in hospital.

Methods
An App was developed for Android smartphone to use the built-in microphone for measuring heart sounds on cardiac apex for 20 – 30 seconds in patients. Heart sounds were visually assessed for the presence of the first and second heart sounds and categorized into good, uncertain or bad quality. The factors affecting the percentage of good-quality heart sound recordings were analyzed, including the patients’ baseline characteristics, medical history and blood test.

Results
Among the 296 patients enrolled, 267 (90%) patients had a good-quality heart sound recording. Good-quality heart sounds were less recorded in emergency room (76%), cardiac care unit (82%), intensive care unit (87%) and neurosurgical intensive care unit (88%). Sex, body mass index, body position (supine vs. sitting), heart rate, medical history of atrial fibrillation, coronary artery disease, heart failure or chronic obstructive pulmonary disease, did not significantly affect heart sound quality (all P &gt; 0.05). An advanced age was related to a lower percentage of good-quality heart sounds (&lt; 60 vs. ≥ 60 years: 94% vs. 87%, P = 0.048). Heart sound quality significantly decreased with red blood cell count, hemoglobin level and hematocrit (all P &lt; 0.001).

Conclusions
Smartphone can be used in hospital settings for measuring heart sounds in good quality, but factors such as department of hospitalization, age and blood indicators need to be considered.Central illustration
The effectiveness of virtual reality on cardiac procedure related anxiety: a systematic review and meta-analysis
Authors: Bashir Z , Misquith C , Has P , Bukhari S 
Published: November 2023

Abstract

Introduction
Cardiac procedures are associated with anxiety which can lead to worse outcomes1 2. However, virtual reality (VR) may offer an innovative approach of a more informative experience enhancing procedural understanding and reducing procedure-related anxiety. Previous studies have shown benefits of VR related therapies in improving anxiety related to cardiac rehabilitation and different surgical procedures3 4.

Purpose
To evaluate the effectiveness of VR in improving cardiac procedure related anxiety compared to standard of care in patients undergoing any type of cardiac procedure. PROSPERO ID CRD 42023395395

Methods
A comprehensive search strategy was used to search the online databases (MEDLINE, EMBASE, CINAHL, Web of Sciences, and COCHRANE) for randomized controlled trials (RCTs) on VR, cardiac procedures, and anxiety. Risk of bias was analyzed using revised Cochrane risk of bias tool for RCTs5. Effect estimate was reported as standardized mean difference (SMD) with a 95% confidence interval. Random effect model was used to generate effect estimate if heterogeneity was significant (I2&gt;60%), otherwise fixed effect model was used. Sensitivity analysis was performed based on the type of anxiety questionnaire used and p-value of &lt;0.05 was taken as statistically significant. Statistical analysis was conducted using Stata SE version 17.0 (College Station, TX, USA) and RevMan5.

Results
A total of 171 study participants were part of four studies included in the meta-analysis. Three studies were part of narrative synthesis. Mean age was between 44±11 years and 83±6.4 years. VR group did not show significant improvement in anxiety compared to standard of care (SMD 0.11, 95% CI -0.90, 1.11). However, significant improvement in anxiety was seen in VR group on sensitivity analysis after including studies that utilized validated anxiety assessment State-Trait Anxiety Inventory (STAI) questionnaire6 only ( (SMD -0.39, 95% CI -0.74, -0.05). Egger’s regression test did not identify any significant publication bias (p=0.64).

Conclusion
Our findings suggest that VR significantly improves anxiety related to cardiac procedures when assessed using validated anxiety questionnaire. Two out of three studies included in the narrative synthesis also showed improvement in anxiety levels, despite using non-standardized questionnaires. However, further studies are needed to investigate the effectiveness of novel VR technology in reducing cardiac procedure-related anxiety while comparing the use of standardized and non-standardized anxiety assessment tools.Forest Plot for Anxiety OutcomeSensitivity take-one-out analysis.
Impacts of social determinant of health on cardiovascular event and mortality risk in community-dwelling population without cardiovascular disease: results of the China PEACE million persons project
Authors: Cai A , Chen C L , Ou Y Q , Wang J B , Nie Z Q , Feng Y Q 
Published: November 2023

Abstract

Aim
To evaluate the impacts of social determinant of health (SDOH) on major adverse cardiovascular event (MACE) and mortality risk in community-dwelling population.

Methods
The China PEACE million persons project is a nationwide, government-funded and population-based cardiovascular disease (CVD) screening study. This was a sub-cohort study of the project that included community-dwelling adults free of CVD from Guangdong Province. Metrics of SDOH, including education attainment, economic stability, health care access, social support and environment/neighborhood, were collected using self-report questionnaires. Each favorable metric was assigned 1 point, and individuals with 0-3 points were defined as low SDOH and those with 4-5 points were defined as high SDOH. MACE (including coronary heart disease/myocardial infarction, stroke, heart failure and cardiovascular death) and all-cause death were identified by linking hospital records.

Results
Among the cohort (n=38571, median age 54 years and women 60.5%), proportion of individuals with low SDOH was 68.9%. After a median follow-up of 3.6 years, compared to the high SDOH group, the low SDOH group had significantly higher event rate of MACE (7.2% vs 5.0%, P&lt;0.001) and all-cause death (1.6% vs 0.9%, P&lt;0.001). After adjusted for covariates, in reference to the high SDOH group, the adjusted hazard ratio (HR) for MACE in the low SDOH group was 1.18 (95% confidence interval [CI] 1.08-1.30) and for all-cause death was 1.35 (95% CI 1.09-1.68).

Conclusion
Low SDOH was associated with an increased risk of MACE and all-cause death. Concerted efforts are needed to reduce health disparities between individuals with low versus high SDOH.Graphical abstract
Outdoor artificial light at night and cardiovascular disease in adults: a Chinese nationwide cohort study
Authors: Hu X , Ou Y , Zhou Y , Dong G , Dong H 
Published: November 2023

Abstract

Background
Although the electric light is a significant promotion in the human progress and civilization, its adverse effects of outdoor artificial light at night (ALAN) are being extensively studied. However, the association of outdoor ALAN and cardiovascular disease (CVD) has never been confirmed in large nationwide studies, especially in urban areas with high exposure levels and in rural areas with low exposure levels, respectively.

Purpose
To explore the association between outdoor ALAN and CVD.

Methods
This national study enrolled 12,686 adults ≥ 40 years across China. The outdoor ALAN exposure (nW/cm2/sr) with the resolution of the 500 meters around each participant's location was obtained from satellite image data via Visible Infrared Imaging Radiometer Suite day-night band on board the Joint Polarorbiting Satellite System. CVD was defined by a doctor's record of diagnoses, including heart disease and stroke. Poisson regression model and restricted cubic spline models were used to estimate the relationship between outdoor ALAN and CVD in urban and rural areas, respectively. Subgroup analysis was also conducted using Poisson models for each subgroup.

Results
At a median follow-up of 7 years, 1,732 cases of CVD were identified. The mean age of the participants was 58 years and 49% were males. In urban areas, outdoor ALAN exposure at the highest quartile (Q4) increased the incidence of CVD among participants by 34% compared to those exposure at the lowest quartile (Q1) (incident rate ratio, IRR: 1.34,95% CI: 1.07—1.69, p = 0.01), adjusting for age, sex, BMI, education, smoke ever, alcohol consumption, physical activity and household consumption. In rural areas, compared with those at the Q1 of outdoor ALAN exposure, exposure at the Q4 reduced the incidence of CVD by 17% (IRR: 0.83, 95% CI: 0.70—0.98, p = 0.028) after full adjustment. Dose-response relationship indicated that outdoor ALAN levels were linearly associated with decreased CVD in rural area (p for non-linearity = 0.370), while the association between outdoor ALAN levels and CVD was shown as an inverse "U" shape in urban area (p for non-linearity ≤ 0.001). Subgroup analysis shown that the CVD risk of middle-aged people, people with history of alcohol consumption, or people with low levels of physical activity were susceptible to outdoor ALAN exposure.

Conclusions
Outdoor ALAN exposure was associated with the risk of CVD, which was heterogeneous with different levels of exposure range. In rural areas with low outdoor ALAN exposure settings, outdoor ALAN exposure was negatively correlated with the risk of developed CVD, while the association was reverse in urban areas with high outdoor ALAN exposure settings. We call for a reduction in the use of high-intensity ALAN and to pay attention to the effects of emotional, psychological, and biological changes associated with outdoor ALAN exposure on cardiovascular health.Figure 1