bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of telemedicine on self-care in heart failure patients: insights from the iCOR randomised controlled trial
Authors: Pons Riverola A , Yun S , Jose N , Hidalgo E , Ruiz M , Alcoberro L , Jimenez S , Moliner P , Ramos R , Ras M , Verdu J M , Garay A , Corbella M , Enjuanes C , Comin-Colet J 
Published: November 2023

Abstract

Background/introduction
Poor self-care in heart failure (HF) patients is well recognised to lead to a worse prognosis, through an increased risk of readmissions and mortality. In this regard, the integration of eHealth-based telemonitoring and tele-intervention tools into integrated HF-care programmes could help to improve the self-care of these patients. Nevertheless, the current evidence regarding the impact of eHealth solutions on the self-care of HF patients is scarce.

Purpose
To evaluate the effect of telemedicine (TM) on self-care behaviour in patients with HF after hospital admission compared to usual care (UC).

Methods
We designed a post-hoc analysis of the "Insuficiència Cardíaca Optimització Remota" (iCOR) study focussing on self-care. iCOR was a randomised, controlled, single-centre proof-of-concept clinical trial, designed to evaluate the efficacy to adding a eHealth-solution to an existing specialised, comprehensive, multidisciplinary, nurse-based, hospital/primary care integrated HF management programme. Participants were randomised to TM or UC after hospital discharge ("vulnerable-phase") and were followed for 6 months. The primary study endpoint of the current analysis was the delta change of self-care after 6 months of follow-up, assessed using European Heart Failure Self-care Behaviour Scale-12 item (EHFScBS-12 item, lower scores meaning better self-care). To assess the change in self-care between the 2 groups, a repeated-measures ANOVA analysis was performed, adjusted for baseline self-care.

Results
178 patients were analysed (81 TM vs 97 UC). The median age of the patients was 74±11 years, 41% were female and the median ejection fraction was 47±17%. Self-care at baseline had a median score of 21.6±10.5 points.
As shown in Figure 1, there were no differences in baseline values of self-care between the two comparison groups (21.9±11 TM vs 21.5±11 UC, p-value &gt; 0.05). Both groups experienced an improvement in self-care over time (p-value 0.002 for time effect). However, patients in the TM group experienced greater improvement (from 21.9±11 to 14±0.7 mean Delta change = -7.9±11) than in the UC (21.3±10.5 to 19±0.7, mean delta change = -2.2±10.4, p-value &lt;0.001 in inter-groups comparison) (Figure 1). We designed several multivariate linear regression models exploring the determinants of self-care at baseline and the determinants of change in self-care over time. As shown in Table 1, baseline self-care and randomisation arm were the only independent predictors of improvement of self-care over time.

Conclusions
Integration of TM into HF care programs can contribute to further improve self-care and thus empowerment in the HF-management.Self-care status changeDeterminants of self-care
Prevalence of sleep apnea by a home diagnostic device in patients with atrial fibrillation
Authors: Hashiba Jensen M , Dalgaard F D , Laub R R L , Gottlieb V G , Nielsen O W N , Hansen J H , Lock Hansen M L H , Jennum P J , Lamberts M L 
Published: November 2023

Abstract

Background
Sleep apnea (SA), a modifiable risk factor in atrial fibrillation (AF), is associated with worse outcomes in AF hence diagnosing SA in patients with AF is clinically important. The gold standard to detect presence of SA is polysomnography which requires an in-patient, overnight stay in a specialized sleep laboratory. The procedure is time-consuming and inconvenient for patients and not widely available. As such, new and more conveniently assessment tools are needed for optimal screening of SA in patients with AF.

Purpose
We aimed to assess the prevalence and severity of SA in patients with AF, and, subsequently, to assess the positive predictive value (PPV) of moderate to severe and only severe SA by home-monitoring in comparison to cardio-respiratory monitoring (CRM) in consecutive patients with AF.

Methods
This cross-sectional study recruited unselected patients with AF without known SA from an out-patient clinic at our University Hospital. Participants underwent four consecutive nights of sleep-recording with the home-monitoring device NightOwl™ (NO). Moderate to severe SA was defined as an Apnea-Hypopnea Index≥15 per hour of sleep. Participants with moderate to severe SA was offered CRM for validation of the diagnosis. Prevalence of SA was calculated by the proportion of participants with moderate to severe SA out of all study participants, and the PPV was calculated as the proportion of moderate to severe and only severe AHI by NO confirmed by CRM.

Results
We included 126 patients with AF with a median age of 68 (interquartile range: 60-75) years, 42 (33%) women, 70 (56%) hypertension, 61 (48%) hyperlipidemia and 49 (39%) heart failure. NO detected severe SA in 36 (29%) of patients with AF, moderate SA in 35 (28%), mild SA in 45 (36%) and no SA in 10 (8%). Of the 71 patients with moderate to severe SA by NO, 38 patients underwent CRM and the PPV of NO was 0.82 (31/38) to diagnose moderate and severe SA and 0.92 (22/24) to diagnose severe SA by CRM.

Conclusion
Moderate to severe SA by NO was highly prevalent in patients with AF without known SA. A home-monitoring device such as NO could be an easy and feasible SA screening tool in patients with AF.Figure 1:PrevalenceTable 1:Baseline Characteristics
Prediction of all-cause mortality using a multisensor implantable defibrillator algorithm for HF monitoring
Authors: D'onofrio A , Manzo M , Bertini M , Santini L , Savarese G , Dello Russo A , Santobuono V E , Lavalle C , Viscusi M , Amellone C , Calvanese R , Santoro A , Ziacchi M , Valsecchi S , Calo L 
Published: November 2023

Abstract

Background
The HeartLogic algorithm combines multiple implantable defibrillator (ICD) sensor data and has proved to be a sensitive and timely predictor of impending heart failure (HF) decompensation.

Purpose
We determined if remotely monitored data from this algorithm can be used to identify patients at high risk of mortality.

Methods
The HeartLogic feature was activated in 568 ICD patients from 26 centers.

Results
During a median follow-up of 26 months [25th–75th percentile: 16-37], 1200 HeartLogic alerts were recorded in 370 (65%) patients. Overall, the time IN the alert state was 13% of the total observation period (151 out of 1159 years) and 20% of the follow-up period of the 370 patients with alerts. During follow-up, 55 patients died (37 in the group with alerts). Experiencing any alert episode was associated with a substantially increased risk of death [hazard ratio (HR): 2.08, 95% confidence interval (CI): 1.16–3.73, P = 0.039]. Additionally, a time IN alert ≥20% was associated with death (HR: 4.07, 95%CI: 2.19-7.54, p&lt;0.001, Figure), even after multivariate correction for age, atrial fibrillation on implantation, chronic kidney disease, ischemic cardiomyopathy (HR: 3.26, 95%CI:1.87-5.70, p&lt;0.001). The rate of death was 0.25/patient-year (95%CI: 0.17-0.34) with the HeartLogic IN the alert state and 0.02/patient-year (95%CI: 0.01-0.03) OUT of the alert state, with an incidence rate ratio of 13.72 (95%CI: 7.62-25.60, p&lt;0.001).

Conclusions
The HeartLogic algorithm provides an index that can be used to identify patients at higher risk of all-cause mortality. The index status identifies periods of significantly increased risk of death.
The TAG P2 score predicts low voltage areas in patients with atrial fibrillation - a novel prediction model
Authors: Dilk P , Marinov K , Nedios S , Dagres N , Bollmann A , Hindricks G , Seewoester T 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is a common cardiac arrhythmia associated with morbidity and mortality. One of the mainstays of AF treatment is the interventional isolation of the pulmonary veins. However, the presence of low voltage areas (LVAs) in the left atrium is associated with a worse outcome after catheter ablation. Therefore, identifying LVAs prior to intervention is important for tailoring individualized treatment approaches. Although several prediction models for LVAs exist, none of them incorporate electrocardiographical parameters. Therefore, this study aimed to develop and evaluate the predictive value of a novel LVAs prediction score that incorporates a novel ECG parameter, prospectively validate the score, and compare it with existing prediction scores.

Methods
The study enrolled 264 patients with AF undergoing catheter ablation. LVAs were determined using high-density maps, which were defined as areas of low voltage amplitude (&lt;0.5 mV). Before intervention, all patients underwent cardiovascular magnetic resonance imaging to measure left atrial dimensions. A novel LVAs prediction score (TAG P²) was established, which included a parameter of cumulative atrial electrical forces in relation to left atrial area (PWAi&lt;0.478 msec * mV * m²/cm² – 2pts), along with type of AF (persistent – 1pt.), age (&gt;70 years - apt.), and gender (female – 1pt.). The score was prospectively validated in a cohort of 126 patients.

Results
The TAG P² score was effective in predicting LVAs in the study population (AUC: 0.918; 95%CI [0.884 to 0.951]; p&lt;0.001) and the results were confirmed in the validation cohort (AUC: 0.884; 95%CI [0.826 to 0.943]; p&lt;0.001). The TAG P² score outperformed existing prediction scores, such as the DR-FLASH (AUC: 0.788; 95%CI [0.685 to 0.891]) and APPLE scores (AUC: 0.764; 95%CI [0.671 to 0.856]).

Conclusion
The TAG P² score, which incorporates a novel ECG parameter (PWAi) effectively predicts LVAs in patients undergoing catheter ablation for AF.
Diagnostic accuracy of a smartphone application for artificial intelligence-based interpretation of 12-lead ECG in primary care (AMSTELHEART-1)
Authors: Himmelreich J C L , Harskamp R E 
Published: November 2023

Abstract

Background
The use of 12-lead electrocardiogram (ECG) is common in routine primary care, however it can be difficult for less experienced ECG readers to adequately interpret the ECG.

Objective
To validate a novel smartphone application as a stand-alone interpretation tool for 12-lead ECG in primary care.

Methods
We recruited consecutive patients who underwent 12-lead ECG as part of routinely indicated primary care in the Netherlands. All ECGs were assessed by a smartphone application which analyses a photographed image of 12-lead ECG for automated interpretation, installed on an Android platform and an iOS platform. We validated the application for detecting: 1) any major ECG abnormality (MEA, primary outcome) defined as atrial fibrillation/flutter (AF), markers of (past) myocardial ischemia or clinically relevant impulse and/or conduction abnormalities; or 2) AF (key secondary outcome). The reference standard was a blinded expert panel.

Results
We included 290 patients from 11 Dutch general practices with median age 67 (IQR 55-74) years, 48% were female. On reference ECG, 71 patients (25%) had MEA, 35 (12%) had AF. The app's sensitivity and specificity for MEA were 86% (95%CI:76-93) and 92% (95%CI:87-95), respectively. For AF, sensitivity and specificity were 97% (95%CI:85-100) and 99% (95%CI:97-100), respectively. Performance was comparable between Android and iOS platform (Kappa=0.95, 95%CI:0.91-0.99 and Kappa=1.00, 95%CI:1.00-1.00 for MEA and AF, respectively).

Conclusions
A smartphone application that interprets photographed 12-lead ECG images had good diagnostic accuracy in a primary care setting for major ECG abnormalities, and near-perfect properties for diagnosing AF.
Self-monitoring using Mobile App to improve symptoms and Reduce rehospitalization and morTality in Heart Failure (SMART-HF trial)i
Authors: Yoon M , Park J J , Lee S H , Jung M H , Youn J C , Shim C Y , Choi J O , Choi J Y , Kim E J , Yoo B S , Son Y J , Choi D J 
Published: November 2023

Abstract

Background
Considering the uncertainty of the benefits of mobile apps in patients with heart failure (HF), we developed a mobile health platform and aimed to evaluate this intervention in terms of improving symptoms and outcomes in HF.

Methods
Seven tertiary hospitals in South Korea participated in this prospective, randomized, open-label, nationwide, multicenter, pilot trial (SMART-HF trial). Patients aged ≥20 years hospitalized for acute heart failure who were able to use a smartphone were enrolled before discharge. Eligible participants were then randomized 1:1 to either the intervention group (AIDA/KT-app with devices) or the control group (AIDA/KT-app only). The mobile health platform consists of three parts: 1) smartphone app for patients (2) dashboard system for physicians (3) clinical decision support system. Only in the intervention group, the applications were automatically paired with a Bluetooth blood pressure monitor, weight scale and body water analyzer. The intervention group were able to enter their HF symptom scale into the app and receive feedback or alerts on their input. In the control group, patients could only enter their blood pressure, weight, and HF symptom into the app, and there are no connected devices and no feedback from the app.

Results
84 patients were randomized to the intervention group (n=43) and control group (n=41). Overall, 62.8% of the patients were male, and the median age was 63.0 years. At 4 weeks, dyspnea score by questionnaire (range 0-10) was 1.5±2.3, and 2.0±2.4 in the intervention and control groups, respectively, and was not significantly different (P=0.415). The total HF symptom score (range 0-12) including dyspnea, fatigue, edema, and palpitation entered by the participants in the apps was not significantly different between two groups (2.0±2.1, and 1.6±2.1, P=0.454). In the intervention group, the level of body water composition showed trend toward decreasing during study period (initial level 7.46 -&gt; final level 6.71, P=0.10). App adherence during the study period was higher in the intervention group compared with control group (70.6±32.5% vs. 47.8±32.0%, P=0.004). App satisfaction scores tended to be higher in the intervention group (7.1±2.6 vs. 6.2±2.9, P=0.147). Secondary composite endpoints including death, rehospitalization, and urgent HF visit were not significantly different between two groups (4/40 vs. 3/38, P=0.999).

Conclusions
Our mobile health platform showed feasibility and efficacy for HF patients although clinical outcomes were not significantly different, maybe due to small sample size. Considering that motivating patients to use the mHealth tool more frequently may lead to greater clinical benefit, further large research with a positive user experience is needed for HF patient care.
Association between empathy levels in physicians and patient satisfaction scores in a cardiovascular clinic
Authors: Sigal A , Baro Vila R C , Massa M , Benzadon M , Gelpi R J , Alves De Lima A E 
Published: November 2023

Abstract

Introduction
A good doctor-patient relationship is crucial to medical practice. A fundamental element that drives this relationship is the empathy of the treating physician, which has also been validated as a predictor of clinical competence and patient results.

Purpose
We conducted an original study to correlate empathy values of our physicians and patient satisfaction surveys. In this subanalysis, we evaluated whether age, sex or time since qualifying as specialist had an impact on empathy values.

Methods
In our originaly study we sought to correlate the empathy values of our physicians in our cardiovascular clinic with the results of outpatient satisfaction surveys, measured with HCAPS, using a linear regression model. The Jefferson Empathy scale is a self reported 20 question survey, answered through a 1-7 Likert scale, with a maximum score of 140 points. It is further subclassified into 3 categories: "Perspective", "Care with compassion" and "Stepping into patient's shoes". The HCAPS survey is a patient satisfaction query, with 5 items that inquire as to the patient's perception of being treated with respect by the physician, the interest shown in their problems, the time dedicated to the consult, and the quality of the explanation of their chief concern and treatment options. It is anwered through a Likert scale from "Totally diasgree" to "Totally agree". There is also a final question that asks for a global impression.

Results
65 doctors answered the Empathy survey, 30.8% of them women. Mean age was 48.8 years, and over half were under 50 years old. 81% had been practicing for over 5 years. 61671 HCAPS surveys were analyzed, corresponding to those 65 practitioners. Mean Empathy score was 120.7 (DS 11.1). We found that patients perceived greater respectful treatment (p=0.03) and had their treatment options better explained to them (p=0.02) by physicians with higher levels of empathy. The other HCAPS queries had a positive, though non statistically significant, relationship with Empathy scores. Doctors with higher scores in the subcategory "stepping into patient's shoes" had a significant increase in patient's perception of the interest shown in their concerns (p=0.01). There were no differences in physicians' empathy levels according to their age, gender, or time since qualifying as a specialist.

Discussion
These results validate empathy as a key skill in the doctor-patient relationship, and show that high levels of this personality attribute lead to better patient satisfaction results. Our results differ from other published work in that we found no difference in empathy levels according to gender or practice time, whereas most previous literature found that women and longer practice time were positively associated with empathy levels.
Knowledge and unmet needs of patients with atrial fibrillation in China: a nationwide cross-sectional survey
Authors: Jiang C X , Liu X X , Yuan L , Yuan H T , Zhu H M , Li N , Xu J , Long D Y , Chen M L , Ma C S 
Published: November 2023

Abstract

Background
Knowledge about the disease and treatment options is necessary for active patient engagement in shared decision-making, which is essential for ’patient-centered’ atrial fibrillation (AF) management.

Purpose
To evaluate the knowledge level and identify unmet needs of patients with AF in China.

Methods
A nationwide cross-sectional survey was conducted using online or paper questionnaires between May and August 2022. Adult AF outpatients or inpatients in China were eligible for participation. The questionnaires included items on knowledge regarding AF, treatment options, risk factors, AF treatment practice, and AF patients’ unmet needs.

Results
This survey included 2,002 patients with AF [mean age 68.62±13.45, 1,040 (52%) men] from 55 centers across 17 provinces in China. Most patients (66.18%) had knowledge scores of &lt; 4 (an 8-item disease knowledge scale, the score ranged from 0 [worst] to 8 [best]), which is a poor knowledge level. Approximately half of the patients did not know that "AF can cause blood clots which can lead to stroke (cerebral infarction)." The proportion of patients who knew about oral anticoagulants, cardiac rhythm/heart rate control drugs, and catheter ablation were 85.96%, 81.37%, and 41.36%, respectively. However, only 79.52%, 72.08%, and 16.18% of patients received these respective treatments. Moreover, only 51.46% of patients were satisfied or very satisfied with their treatments. The improvement in life quality, prevention and treatment of complications, and symptom control were the three most important aspects for patients when choosing treatments. The impact of AF on daily activities, sleep, emotions, and memory were reported by 80.77%, 63.54%, 52.80%, and 66.18% patients, respectively. Most patients with AF recognized hypertension (87.50%) and diabetes mellitus (50.33%) as risk factors, but few recognized obesity and excessive alcohol intake. Overall, 93.56% of patients obtained AF knowledge from physicians. They expect the source of knowledge to include regular community education(61.29%), as well as digital tools(58.74%) between physicians and patients. Furthermore, 90.86% of patients considered involvement in treatment decisions necessary.

Conclusions
This study reveals that the knowledge level of patients with AF in China regarding the disease and treatment options is insufficient, and there remain unmet needs for AF management. Thus, more patient-centered education through multiple channels is required to improve patients' involvement in treatment decisions.
Association between psychological distress and cardiovascular health amongst cancer survivors in the United States: findings from nationally representative data
Authors: Chan J S K , Satti D I , Dee E C , Sharma G , Virani S S , Liu T , Tse G 
Published: November 2023

Abstract

Background
Although both psychological distress and cancer are associated with worse cardiovascular health, the associations between psychological distress and cardiovascular health in cancer survivors are unclear and requires delineation, especially as the number of long-term cancer survivors increases.

Purpose
To investigate the relationship between psychological distress and cardiovascular health amongst cancer survivors.

Methods
This cross-sectional study used data from the 2013-2017 National Health Interview Survey, an annual survey representative of the non-institutionalized population of the United States. Subjects with missing data for any of the exposure, outcome, or covariates were excluded. Psychological distress was measured by the six-item Kessler scale (K6), and severe psychological distress (SPD) was defined as K6 ≥13. Cardiovascular health (CVH) was quantified based on the American Heart Association’s Life’s Essential Eight. As dietary data was unavailable, the score included seven binary items (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity, inadequate sleep, and obesity), with higher scores indicating worse CVH. Multivariable Poisson regression was used to test associations between SPD and CVH, adjusting for the presence of any known cardiac condition, family income, education level, race, sex, sexual orientation, insurance coverage, and age.

Results
Altogether, 138,001 subjects (weighted population of 203,223,831) were analysed, of whom 13,485 (weighted population of 17,648,471) were cancer survivors. SPD was independently associated with worse cardiovascular health both in cancer survivors (adjusted risk ratio (aRR) 1.24 [95% confidence interval: 1.19, 1.29], p&lt;0.001) and those without known cancer (aRR 1.41 [1.39, 1.44], p&lt;0.001), but the association was weaker in the former (pinteraction=0.001). The relationships were grossly linear in both groups of patients (Figure 1). Amongst cancer survivors, SPD was independently associated with all components of the cardiovascular health score except obesity (all p&lt;0.05). Furthermore, amongst cancer survivors, the association was stronger in those who were younger (pinteraction&lt;0.05) or female (pinteraction=0.014), but did not differ significantly by family income, race, or the presence of known cardiac conditions (Figure 2). The association remained significant for most cancer sites.

Conclusions and relevance
SPD was associated with worse cardiovascular health amongst cancer survivors, especially young, female patients, although the association was weaker than that in non-cancer subjects. These highlighted the importance of a multidisciplinary approach with careful psychological assessments in the care of cancer survivors, while shedding light on the patients who may benefit most from future quality improvement programs.Figure 1Figure 2