Abstract 204: Impact of Global Budgets on Hospital Cardiovascular Care in Maryland

Abstract Aims Mobile, portable ECG-recorders allow the assessment of heart rhythm in out-of-hospital conditions and may prove useful for monitoring patients with cardiovascular diseases. However, the effectiveness of these portable devices has not been tested in everyday practice. Methods and results A group of 98 consecutive cardiology patients (62 males [63%], mean age 69 ± 12.9 years) were included in an academic care centre. For each patient, a standard 12-lead electrocardiogram (SE), as well as a Kardia Mobile 6L (KM) and Istel (IS) HR-2000 ECG were performed. Two groups of experienced physycians analyzed obtained recordings. After analyzing ECG tracings from SE, KM, and IS, quality was marked as good in 82%, 80%, and 72% of patients, respectively (p < 0.001). There were no significant differences between devices in terms of detecting sinus rhythm (SE [60%, n = 59], KM [58%, n = 56], and IS [61%, n = 60]; SE vs KM p = 0.53; SE vs IS p = 0.76) and atrial fibrillation (SE [22%, n = 22], KM [22%, n = 21], and IS [18%, n = 18]; (SE vs KM p = 0.65; SE vs IS = 0.1). KM had a sensitivity of 88.1% and a specificity of 89.7% for diagnosing sinus rhythm. IS showed 91.5% and 84.6% sensitivity and specificity, respectively. The sensitivity of KM in detecting atrial fibrillation was higher than IS (86.4% vs. 77.3%), but their specificity was comparable (97.4% vs. 98.7%). Conclusion Novel, portable devices are useful in showing sinus rhythm and detecting atrial fibrillation in clinical practice. However, ECG measurements concerning conduction and repolarisation should be clarified with a standard 12-lead electrocardiogram.

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Social determinants of telemedicine utilization in ambulatory cardiovascular patients during the COVID-19 pandemic

European Heart Journal - Digital Health ◽

10.1093/ehjdh/ztab039 ◽

2021 ◽

Author(s):

Kemar J Brown ◽

Njambi Mathenge ◽

Daniela Crousillat ◽

Jaclyn Pagliaro ◽

Connor Grady ◽

...

Keyword(s):

Statistical Significance ◽

The Elderly ◽

P Value ◽

Chi Square ◽

Cardiovascular Patients ◽

Baseline Characteristics ◽

Racial Ethnic ◽

Cardiovascular Care ◽

Zip Code ◽

Hispanic White

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in the rapid uptake of telemedicine (TM) for routine cardiovascular care. Objectives To examine the predictors of TM utilization among ambulatory cardiology patients during the COVID-19 pandemic. Methods In this single centre retrospective study, all ambulatory cardiovascular encounters occurring between March 16th - June 19th, 2020 were assessed. Baseline characteristics by visit type (in-person, TM-phone, TM-video) were compared using Chi-square and student t-tests, with statistical significance defined by p value < 0.05. Multivariate logistic regression was used to explore the predictors of TM versus in-person care. Results 8446 patients (86% Non-Hispanic White, 42% female, median age 66.8 +/- 15.2 years) completed an ambulatory cardiovascular visit during the study period. TM-phone (n = 4,981, 61.5%) was the primary mode of ambulatory care followed by TM-video (n = 2693, 33.2%). Non-Hispanic Black race (OR 0.56; 95% CI: 0.35 - 0.94, p-value=0.02), Hispanic ethnicity (OR 0.53; 95% CI: 0.29 - 0.98, p = 0.04), public insurance (Medicaid OR 0.50; 95% CI:0.32 – 0.79, p = 0.003, Medicare OR 0.65; 95% CI: 0.47– 0.89, p = 0.009), zip-code linked median household income (MHI) of <$75,000, age >85 years, and patients with a diagnosis of heart failure were associated with reduced access to TM-video encounters and a higher likelihood of in-person care. Conclusions Significant disparities in TM-video access for ambulatory cardiovascular care exist among the elderly, lower income, as well as Black and Hispanic racial/ethnic groups.

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Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Circulation ◽

10.1161/cir.0000000000000896 ◽

2020 ◽

Vol 142 (16_suppl_1) ◽

Cited By ~ 4

Author(s):

Robert Greif ◽

Farhan Bhanji ◽

Blair L. Bigham ◽

Janet Bray ◽

Jan Breckwoldt ◽

...

Keyword(s):

Cardiopulmonary Resuscitation ◽

Performance Feedback ◽

Life Support ◽

Task Force ◽

Treatment Recommendations ◽

Treatment Recommendation ◽

Opioid Overdose ◽

International Consensus ◽

Scoping Reviews ◽

Cardiovascular Care

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations , the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

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ADDRESSING CARDIOVASCULAR HEALTH DISPARITIES: UTILIZING TEAM BASED CARE TO IMPROVE RURAL CARDIOVASCULAR CARE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)32660-3 ◽

2018 ◽

Vol 71 (11) ◽

pp. A2119

Author(s):

Charlene G. Shallow ◽

John Gill ◽

Kristin Doster ◽

Julie Thompson ◽

Angela Bentley

Keyword(s):

Health Disparities ◽

Cardiovascular Health ◽

Team Based Care ◽

Cardiovascular Health Disparities ◽

Cardiovascular Care

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Barriers and facilitators of the uptake of digital health technology in cardiovascular care: a systematic scoping review

European Heart Journal - Digital Health ◽

10.1093/ehjdh/ztab005 ◽

2021 ◽

Author(s):

Sera Whitelaw ◽

Danielle M Pellegrini ◽

Mamas A Mamas ◽

Martin Cowie ◽

Harriette G C Van Spall

Keyword(s):

Organizational Support ◽

Quantitative Methods ◽

Digital Health ◽

Healthcare Delivery ◽

Health Technology ◽

Barriers And Facilitators ◽

User Friendliness ◽

Eligibility Criteria ◽

Patient Level ◽

Cardiovascular Care

Abstract Digital health technology (DHT) has the potential to revolutionize healthcare delivery but its uptake has been low in clinical and research settings. The factors that contribute to the limited adoption of DHT, particularly in cardiovascular settings, are unclear. The objective of this review was to determine the barriers and facilitators of DHT uptake from the perspective of patients, clinicians, and researchers. We searched MEDLINE, EMBASE, and CINAHL databases for studies published from inception to May 2020 that reported barriers and/or facilitators of DHT adoption in cardiovascular care. We extracted data on study design, setting, cardiovascular condition, and type of DHT. We conducted a thematic analysis to identify barriers and facilitators of DHT uptake. The search identified 3075 unique studies, of which 29 studies met eligibility criteria. Studies employed: qualitative methods (n = 13), which included interviews and focus groups; quantitative methods (n = 5), which included surveys; or a combination of qualitative and quantitative methods (n = 11). Twenty-five studies reported patient-level barriers, most common of which were difficult-to-use technology (n = 7) and a poor internet connection (n = 7). Six studies reported clinician-level barriers, which included increased workload (n = 4) and a lack of integration with electronic medical records (n = 3).Twenty-four studies reported patient-level facilitators, which included improved communication with clinicians (n = 10) and personalized technology (n = 6). Four studies reported clinician-level facilitators, which included approval and organizational support from cardiology departments and/or hospitals (n = 3) and technologies that improved efficiency (n = 3). No studies reported researcher-level barriers or facilitators. In summary, internet access, user-friendliness, organizational support, workflow efficiency, and data integration were reported as important factors in the uptake of DHT by patients and clinicians. These factors can be considered when selecting and implementing DHTs in cardiovascular clinical settings.

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