scholarly journals Phenotypes of engagement with mobile health technology for heart rhythm monitoring

JAMIA Open ◽  
2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Jihui Lee ◽  
Meghan Reading Turchioe ◽  
Ruth Masterson Creber ◽  
Angelo Biviano ◽  
Kathleen Hickey ◽  
...  
Keyword(s):  
Mobile Health ◽  
Multinomial Logistic Regression ◽  
Secondary Analysis ◽  
Heart Rhythm ◽  
Important Variable ◽  
Left Ventricular ◽  
Older Age ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Clinical Records

Abstract Objectives Guided by the concept of digital phenotypes, the objective of this study was to identify engagement phenotypes among individuals with atrial fibrillation (AF) using mobile health (mHealth) technology for 6 months. Materials and Methods We conducted a secondary analysis of mHealth data, surveys, and clinical records collected by participants using mHealth in a clinical trial. Patterns of participants’ weekly use over 6 months were analyzed to identify engagement phenotypes via latent growth mixture model (LGMM). Multinomial logistic regression models were fitted to compute the effects of predictors on LGMM classes. Results One hundred twenty-eight participants (mean age 61.9 years, 75.8% male) were included in the analysis. Application of LGMM identified 4 distinct engagement phenotypes: “High-High,” “Moderate-Moderate,” “High-Low,” and “Moderate-Low.” In multinomial models, older age, less frequent afternoon mHealth use, shorter intervals between mHealth use, more AF episodes measured directly with mHealth, and lower left ventricular ejection fraction were more strongly associated with the High-High phenotype compared to the Moderate-Low phenotype (reference). Older age, more palpitations, and a history of stroke or transient ischemic attack were more strongly associated with the Moderate-Moderate phenotype compared to the reference. Discussion Engagement phenotypes provide a nuanced characterization of how individuals engage with mHealth over time, and which individuals are more likely to be highly engaged users. Conclusion This study demonstrates that engagement phenotypes are valuable in understanding and possibly intervening upon engagement within a population, and also suggests that engagement is an important variable to be considered in digital phenotyping work more broadly.

scholarly journals Clinical and laboratory associations of liver fibrosis indexes in patients with decompensated Chronic Heart Failure II-IV Functional Classes

Kardiologiia ◽  
2020 ◽  
Vol 60 (5) ◽  
pp. 90-99
Author(s):  
S. K. Stolbova ◽  
N. A. Dragomiretskaya ◽  
I. G. Beliaev ◽  
V. I. Podzolkov
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Liver Fibrosis ◽  
Hepatic Fibrosis ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Heart Rhythm Disorders ◽  
High Liver

Aim To study clinical and laboratory associations of hepatic fibrosis indexes in patients with decompensated NYHA functional class II-IV chronic heart failure (CHF).Material and methods The study included 128 patients admitted to the cardiological or therapeutic department of the University Clinical Hospital #4 at the I. M. Sechenov First Moscow State Medical University (Sechenov University) with symptoms of CHF associated with ischemic heart disease (IHD) and/or arterial hypertension (AH). All patients had signs of liver disease (liver enlargement on physical examination ± diffuse changes in hepatic tissue according to ultrasound data). Mean age was 70.59±10.71 years. Along with general clinical examination, severity of hepatic fibrosis was evaluated by calculated indexes, FIB-4, APRI, MELD-XI, and BARD. All calculations were based on laboratory data obtained within the first two days of hospitalization for decompensated CHF, at the onset of active therapy with intravenous diuretics. Statistical analyses were performed with the R programming language (3.6.1).Results In patients with NYHA FC II–IV CHF, the FIB-4 index significantly increased with the increase in NYHA FC (р<0.05). Also, the high liver density by most fibrosis indexes correlated with the probability of LV EF decrease to <40 % (FIB-4: RR, 1.32 at 95 % CI from 0.53 to 3.28, р=0.079; MELD-XI: RR, 1.62 at 95 % CI from 1.19 to 2.20, р=0.004; BARD: median LV EF, 42.5 % vs. 56 %, р=0.019), and a tendency to heart rhythm disorders was observed (FIB-4: RR, 1.92 at 95 % CI from 0.75 to 4.90, р=0.218; BARD: RR, 1.09 at 95 % CI from 0.97 to 1.22, р=0.174; MELD-XI: RR, 1.34 at 95 % CI from 0.94 to 1.90, р=0.101). Increases in liver fibrosis indexes correlated with other multiorgan disorders in CHF patients evident as a decrease in platelet count (FIB-4: р<0.01; APRI: р=0.045) and a tendency to a decrease in hemoglobin (FIB-4: 127 g/l vs. 137 g/l, p=0.249; APRI: 127 g/l vs. 136 g/l, p=0.749). Patients with a high liver density more frequently had cardiorenal syndrome diagnosed by reduced glomerular filtration rate (GFR) estimated by CKD-EPI to less than 60 ml/min / 1.73 m2 (FIB-4: р<0.03; MELD-XI: p=0.0001; BARD: р=0.005). In comparing liver fibrosis indexes in subgroups of CHF patients with preserved and reduced left ventricular ejection fraction (LV EF), significant differences were found only for MELD-XI (12.08 vs. 9.32, р=0.001).Conclusions For all studied indexes, correlations were observed with LV EF, decreases in hemoglobin, and incidence of heart rhythm disorders. For the BARD, FIB-4, and MELD-XI indexes, high results of calculations correlated with the presence of other predictors for unfavorable prognosis and disease severity (LV EF, NYHA FC, presence of type 2 diabetes mellitus, chronic kidney disease, and lower GFR). Liver fibrosis indexes are a new and promising but understudied instrument for evaluation of prognosis in CHF patients, which requires further study to determine most appropriate prognostic formulas.

scholarly journals Usefulness of heart rhythm complexity in heart failure detection and diagnosis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Cheng-Hsuan Tsai ◽  
Hsi-Pin Ma ◽  
Yen-Tin Lin ◽  
Chi-Sheng Hung ◽  
Shan-Hsuan Huang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Complexity Analysis ◽  
Heart Rhythm ◽  
Failure Detection ◽  
Left Ventricular ◽  
Multiscale Entropy ◽  
Left Ventricular Ejection ◽  
Fluctuation Analysis ◽  
Ventricular Ejection Fraction ◽  
Detection And Diagnosis

Abstract Heart failure (HF) is a major cardiovascular disease worldwide, and the early detection and diagnosis remain challenges. Recently, heart rhythm complexity analysis, derived from non-linear heart rate variability (HRV) analysis, has been proposed as a non-invasive method to detect diseases and predict outcomes. In this study, we aimed to investigate the diagnostic value of heart rhythm complexity in HF patients. We prospectively analyzed 55 patients with symptomatic HF with impaired left ventricular ejection fraction and 97 participants without HF symptoms and normal LVEF as controls. Traditional linear HRV parameters and heart rhythm complexity including detrended fluctuation analysis (DFA) and multiscale entropy (MSE) were analyzed. The traditional linear HRV, MSE parameters and DFAα1 were significantly lower in HF patients compared with controls. In regression analysis, DFAα1 and MSE scale 5 remained significant predictors after adjusting for multiple clinical variables. Among all HRV parameters, MSE scale 5 had the greatest power to differentiate the HF patients from the controls in receiver operating characteristic curve analysis (area under the curve: 0.844). In conclusion, heart rhythm complexity appears to be a promising tool for the detection and diagnosis of HF.

Abstract 16813: The Prevalence and Predictors of Pacing-Induced Cardiomyopathy (PICM) in Younger Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Dan L Li ◽  
Zachary Yoneda ◽  
Tariq Z Issa ◽  
Jay A Montgomery ◽  
Ben B Shoemaker
Keyword(s):  
Multivariate Analysis ◽  
Left Ventricular ◽  
Interquartile Range ◽  
Older Age ◽  
Left Ventricular Ejection ◽  
Ventricular Pacing ◽  
Ventricular Ejection Fraction ◽  
Younger Patients ◽  
Increased Risk

Background: Pacing-induced cardiomyopathy (PICM) has been increasingly recognized as a cause of heart failure in patients with pacemakers. Thus far, clinical trials and observational studies of PICM have largely included elderly patients with mean age > 70 years. The prevalence and predictors of PICM in younger patients (age ≤ 59 years) after pacemaker implantation are not known. Methods: We retrospectively studied the prevalence and predictors of PICM in younger adults (18-59 years) who received single ventricular chamber or dual chamber pacemakers at Vanderbilt University Medical Center from 1986-2015. Patients without documented ventricular pacing burden, and patients with baseline left ventricular ejection fraction (LVEF) < 30% were excluded. PICM was defined as LVEF drop of ≥ 10% and LVEF < 50% during follow up in the setting of significant right ventricular pacing (≥ 20%), without alternative explanations for cardiomyopathy. Univariate and multivariable Cox proportional hazards regression models were utilized to study the factors associated with hazard of developing PICM. Results: A total of 325 patients were included in the study. 182 patients had high ventricular pacing (≥ 20%), which was associated with pre-existing atrial fibrillation (AF) and reduced baseline LVEF in addition to atrioventricular block (AVB) in the multivariate analysis. During the median follow up duration of 11.5 (Interquartile range 7 - 17) years, 38 patients (11.7%) developed PICM (1.3 per 100 patient-year). The median time to the development of PICM was 5 (Interquartile range 2 - 10) years. Older age (HR 2.5 for age ≥ 50 years, P = 0.013), reduced baseline LVEF (HR 2.4, P = 0.022), and AVB (HR 2.7, P = 0.007) were associated with an increased risk of PICM in the multivariate analysis. Furthermore, pre-existing AF was associated with an increased risk of PICM in patients without pre-implant AVB (HR 8.8 compared to the absence of both AF and AVB, P = 0.039). Conclusion: The incidence of PICM in young patients was low in this cohort of younger patients. Older age, baseline reduced LVEF, and AVB were associated with an increased risk of PICM in the young patient cohort. AF was associated with an increased risk of PICM in a subset of patients without pre-existing AVB at implant.

scholarly journals Long-Term, Single-Centre Observation of Patients with Cardiac Implantable Electronic Devices

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1357
Author(s):  
Roman Załuska ◽  
Anna Milewska ◽  
Anastasius Moumtzoglou ◽  
Marcin Grabowski ◽  
Wojciech Drygas
Keyword(s):  
Heart Rhythm ◽  
Treatment Method ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Single Centre ◽  
Cardiac Pacemakers ◽  
Term Survival ◽  
Ventricular Ejection Fraction ◽  
Conduction Disturbances

Background and Objectives: Electrotherapy is a valuable treatment method for patients with heart rhythm disturbances. There are very few observations of long-term patients treated with these techniques. There is a particular lack of this type of study conducted in Eastern European countries. The aim of this single-centre analysis was to evaluate the long-term survival (from 2010 to 2018) of patients treated with electrotherapy devices, taking into account clinical factors facilitating the prognosis of these patients. Materials and Methods: The patients (N = 2071) subsequently included in the study were subjected to the implementation or replacement of cardiac pacemakers. The medical records of all the patients were analysed. Data concerning death, made available by the State Systems Department of the Ministry of Administration and Digitization, were used. Results: The patients with VVI pacemakers had the worst prognosis after the replacement of the devices. Male patients had a worse prognosis, regardless of the kind of device implanted. Advanced atrioventricular conduction disturbances, chronic kidney disease, and hypothyroidism with reduced left ventricular ejection fraction were among the most significant coexisting diseases. Conclusions: The long-term prognosis of patients under different forms of electrotherapy remains poor. Despite the more straightforward technique, a single-chamber device (VVI/AAI) or generator replacement leads to the worst prognosis. The complexity of the clinical picture that stems from coexisting diseases and advanced age is of the utmost importance.

scholarly journals Which patients with atrial fibrillation undergo an ablation procedure today in Europe? A report from the ESC-EHRA-EORP Atrial Fibrillation Ablation Long-Term and Atrial Fibrillation General Pilot Registries

EP Europace ◽  
2019 ◽  
Vol 22 (2) ◽  
pp. 250-258 ◽  
Author(s):  
Roland Richard Tilz ◽  
Nikolaos Dagres ◽  
Elena Arbelo ◽  
Carina Blomström-Lundqvist ◽  
Harry J Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Atrial Fibrillation Ablation ◽  
Left Ventricular Ejection ◽  
Web Based ◽  
Ventricular Ejection Fraction ◽  
Af Ablation ◽  
Atrial Size

Abstract Aims Rhythm control management in patients with atrial fibrillation (AF) may be unequal across Europe. The aim of this study was to investigate how selective the patient cohort referred for AF ablation is, as compared to the general AF population in Europe, and to describe the governing mechanisms for such selection. Methods and results Descriptive comparative statistical analyses of the baseline characteristics were performed between the cohorts of Atrial Fibrillation Ablation Long-Term (ESC EORP AFA-LT) registry, designed to provide a picture of contemporary real-world AF ablation, and the AF population from the AF-General (ESC EORP AF-Gen) pilot registry. Data collection was performed using a web-based system. In the AFA and in the Atrial Fibrillation General (AFG) pilot registries, 3593 and 3049 patients were enrolled, respectively. Patients who underwent AF ablation were younger, more commonly male, and had significantly less comorbidities. Atrial Fibrillation Ablation patients often presented without comorbidities, resulting in a lower risk of stroke (CHA2DS2-VASc ≥5: 2.9% vs. 24.5%, all P &lt; 0.001) and bleeding (HAS-BLED ≥2: 8.5% vs. 40.5%, P &lt; 0.001) but with European Heart Rhythm Association (EHRA) scores &gt;1 and more prevalent AF-related symptoms such as palpitations, fatigue, and weakness (all P &lt; 0.001) as compared to the general AF patients. Atrial Fibrillation Ablation patients were significantly more often male, had higher left ventricular ejection fraction (59.5% vs. 52.4%) and smaller left atrial size on echocardiogram (P &lt; 0.001 each). Conclusion The comparison of the patient cohorts in the AFA and AFG registries showed that AF ablation in European clinical practice is mostly performed in relatively young, symptomatic and relatively healthy patients.

scholarly journals Telemetric electrocardiography in diagnostics of cardiotoxic heart rhythm disorders and conductivity in oncologic patients

2020 ◽  
Vol 11 (2) ◽  
pp. 16-22 ◽  
Author(s):  
Nadezhda P. Lyamina ◽  
Irena V. Pogonchenkova ◽  
Svetlana V. Lyamina
Keyword(s):  
Cancer Patients ◽  
Heart Rhythm ◽  
Left Ventricular ◽  
Dynamic Monitoring ◽  
Left Ventricular Ejection ◽  
Ecg Changes ◽  
Ventricular Ejection Fraction ◽  
Telemedicine Consultation ◽  
Heart Rhythm Disorders ◽  
Oncologic Patients

Aim.Assessment of the possibility to use ECG-telemetry in order to increase the efficiency of cardiotoxic effect diagnosis in cancer patients with chemotherapy. Material and methods.Remote dynamic monitoring for 6 months was carried out in 31 cardio-oncological patients (in 17 prostate cancer (PC), in 14 breast cancer (BC), mean age was 53.6 (50.1; 56.8) years and 48.3 (38.8; 57.1) years, respectively; FC NYHA IIII; left ventricular ejection fraction 47.4% (40.2; 57.3) and 43.2% (39.7; 58.9), respectively; Mini-Mental State Examination from 30 to 24 points 27.6 (25.4; 29,1) and 28.2 (25.1; 28.8), respectively. ECG-telemetry was performed according to the principle of auto-translation using individual ECG recorders, mobile devices and the ECG Dongle Internet application (Nordavind-Dubna, Russia). Storage, analysis of information and telemedicine consultation was perfomed with the CardioСloud asynchronous tele-cardiological platform. ECG was registered with a frequency of at least 5 times/day and additionally repeatedly in the presence of symptoms and patient desires, duration 1020 minutes. Results.Previously undocumented ECG changes were remotely recorded in patients for 6 months of follow-up: in 87.0% of patients sinus tachycardia, against which ventricular extrasystole of various gradations (32.3%), supraventricular extrasystole (22.6%), transient tachy-dependent blockade of the bundle of His legs were recorded (9.7%). In 64.7% of PC patients and in 42.8% of BC patients rhythm disturbances were detected in combination with depression of theSTsegment. Paroxysms of atrial fibrillation were reported in 17.6% of PC patients and in 14.3% BC patients. In 35.5% of patients the detected ECG changes were asymptomatic. Conclusion.Remote dynamic monitoring in cancer patients receiving chemotherapy involving ECG recording scheme (5 times/day, 1020 min) with ECG telemetry is an effective and unexpensive method for detecting ECG changes in the phenomenon of cardiotoxicity.

scholarly journals Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry

2019 ◽  
Vol 40 (26) ◽  
pp. 2142-2151 ◽  
Author(s):  
Sebastiano Gili ◽  
Victoria L Cammann ◽  
Susanne A Schlossbauer ◽  
Ken Kato ◽  
Fabrizio D’Ascenzo ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Acute Phase ◽  
Pulseless Electrical Activity ◽  
Heart Rhythm ◽  
Female Gender ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Takotsubo Syndrome ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation

Abstract Aims We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). Methods and results We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. Conclusions Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.

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