JMIR有氧运动

评估医疗保健提供者对使用移动应用程序支持心衰患者管理的观点:定性描述性研究

2022 - 10 - 26 - t09:30:19内

背景:心衰患者不坚持饮食和药物治疗可导致心衰预后不良。移动应用程序可能是提高依从性的一种有前途的方式，因为它们通过教育和监控增加知识和行为改变。设计良好的应用程序，加上医疗保健提供者(HCPs)的输入，可以在实践中成功采用这类应用程序。然而，很少有人知道HCPs对使用移动应用程序支持心衰管理的观点。本研究的目的是确定HCPs在使用移动应用程序支持心衰患者管理方面的观点(需求、动机和挑战)。在创新扩散理论的指导下，采用一对一的半结构化访谈对HF HCPs(包括心内科医生、护士和护理从业人员)进行了定性描述性研究。抄本由2名研究人员独立编码，并使用内容分析进行分析。21名HCPs(心脏病学家:n=8, 38%;护士:n = 6, 29%;护理从业人员:n=7, 33%)通过5个主题确定了应用程序采用的挑战和机会:参与者感知的影响应用程序采用的因素 -这些因素包括患者年龄、技术熟练程度、技术可及性和易用性; improved delivery of care—apps can support remote care; collect, share, and assess health information; identify adverse events; prevent hospitalizations; and limit clinic visits; facilitating patient engagement in care—apps can provide feedback and reinforcement, facilitate connection and communication between patients and their HCPs, support monitoring, and track self-care; providing patient support through education—apps can provide HF-related information (ie, diet and medications); and participant views on app features for their patients—HCPs felt that useful apps would have reminders and alarms and participative elements (gamification, food scanner, and quizzes). Conclusions: HCPs had positive views on the use of mobile apps to support patients with HF management. These findings can inform effective development and implementation strategies of HF management apps in clinical practice.

基于心率和身体加速的成人心血管危险因素心肺适合度评估:验证研究

2022 - 10 - 25 - t10:30:19内

背景:心肺适合度(CRF)是心血管疾病发病率和死亡率的独立危险因素。将CRF添加到传统的危险因素(如吸烟、高血压、糖代谢障碍和血脂异常)中，可以改善对个人不良健康结果风险的预测，如与心血管疾病相关的风险。因此，建议确定CRF作为个体化风险预测的一部分。然而，在日常临床实践中，CRF并不是常规测定的。可穿戴技术提供了一种潜在的每日CRF评估策略，这种基于心率和身体加速提供CRF评估的技术已经开发出来。然而，这些技术在临床相关人群中评估个体CRF的有效性尚不清楚。本研究的目的是评估一种可穿戴技术的有效性，该技术可在有心血管危险因素的工作年龄成人中提供基于心率和身体加速度的估计CRF。方法:总共74名成人(年龄范围35-64岁;N =56, 76%为女性;平均BMI 28.7, SD 4.6 kg/m²)，常见心血管危险因素(n=64, 86%高血压; n=18, 24% prediabetes; n=14, 19% type 2 diabetes; and n=51, 69% metabolic syndrome) performed a 30-minute self-paced walk on an indoor track and a cardiopulmonary exercise test on a treadmill. CRF, quantified as peak O₂ uptake, was both estimated (self-paced walk: a wearable single-lead electrocardiogram device worn to record continuous beat-to-beat R-R intervals and triaxial body acceleration) and measured (cardiopulmonary exercise test: ventilatory gas analysis). The accuracy of the estimated CRF was evaluated against that of the measured CRF. Results: Measured CRF averaged 30.6 (SD 6.3; range 20.1-49.6) mL/kg/min. In all participants (74/74, 100%), mean difference between estimated and measured CRF was −0.1 mL/kg/min (P=.90), mean absolute error was 3.1 mL/kg/min (95% CI 2.6-3.7), mean absolute percentage error was 10.4% (95% CI 8.5-12.5), and intraclass correlation coefficient was 0.88 (95% CI 0.80-0.92). Similar accuracy was observed in various subgroups (sexes, age, BMI categories, hypertension, prediabetes, and metabolic syndrome). However, mean absolute error was 4.2 mL/kg/min (95% CI 2.6-6.1) and mean absolute percentage error was 16.5% (95% CI 8.6-24.4) in the subgroup of patients with type 2 diabetes (14/74, 19%). Conclusions: The error of the CRF estimate, provided by the wearable technology, was likely below or at least very close to the clinically significant level of 3.5 mL/kg/min in working-aged adults with cardiovascular risk factors, but not in the relatively small subgroup of patients with type 2 diabetes. From a large-scale clinical perspective, the findings suggest that wearable technologies have the potential to estimate individual CRF with acceptable accuracy in clinically relevant populations.

CARRIER联盟提出的减少动脉粥样硬化性心血管疾病负担的数字健康解决方案

2022 - 10 - 17 - t09:30:02内

对于动脉粥样硬化性心血管疾病(ASCVD)风险升高的人群和已有疾病的患者，数字健康是一种很有前途的工具，可用于改善心血管预后。已经制定和实施了许多数字卫生举措。然而，大规模实施的障碍仍然存在。本文关注这些障碍，并提出了荷兰CARRIER(即冠状动脉疾病:风险估计和干预预防和早期发现)联盟提出的解决方案。我们将分4个部分关注以下内容:(1)电子健康解决方案的开发过程，包括设计思考和与相关利益相关者的共同创造;(2)两种临床预测模型(CPMs)的建模方法，以识别有发展ASCVD风险的人群并指导干预;(3)联邦数据基础设施的描述，用于培训cpm并向eHealth解决方案提供相关数据;(4)讨论卫生保健中负责任的数据处理的伦理和法律框架。荷兰CARRIER联盟由电子卫生发展、ASCVD、公共卫生、大数据以及伦理和法律等领域的专家合作组成。该联盟专注于减轻ASCVD的负担。 We believe the future of health care is data driven and supported by digital health. Therefore, we hope that our research will not only facilitate CARRIER consortium but may also facilitate other future health care initiatives.

在少数民族人口中实施、吸收和使用与心脏代谢疾病相关的数字卫生干预措施的框架:范围审查

2022 - 08 - 11 - t10:00:38内

在COVID-19大流行之前和期间，数字卫生干预措施在卫生保健领域已变得越来越普遍。在实施数字卫生干预措施的框架中，可能不考虑卫生不平等，特别是种族不平等。我们考虑的框架包括描述或预测数字卫生干预措施的实施、吸收和使用的任何模型、理论或分类法。我们的目标是评估如何在与数字卫生干预措施的实施、吸收和使用有关的框架中解决卫生不平等问题;保健和种族不平等;以及对心脏代谢疾病的干预方法:搜索SCOPUS、PubMed、EMBASE、谷歌Scholar和灰色文献，以确定与数字卫生干预的实施、吸收和使用相关的框架的论文;种族或文化多样化的人口和健康不平等;以及对心脏代谢疾病的干预我们评估了各种框架在何种程度上解决了卫生不平等，特别是种族不平等; explored how they were addressed; and developed recommendations for good practice. Results: Of 58 relevant papers, 22 (38%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease. Conclusions: Existing frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies. Trial Registration:

远程医疗使用与充血性心力衰竭患者的医疗保健使用变化和预后之间的关联:回顾性队列研究

2022 - 08 - 04 - t09:45:40内

背景:由于COVID-19大流行，远程医疗的使用已变得广泛，但其对患者预后的影响尚不清楚。我们试图调查远程医疗使用对充血性心力衰竭(CHF)患者的医疗保健使用变化和临床结局的影响。我们使用加拿大安大略省的行政数据进行了一项基于人群的回顾性队列研究。如果患者在2020年3月14日至9月30日期间至少有一次门诊，并在2020年3月14日之前的任何时间被诊断为心力衰竭，则纳入研究。基于若干基线特征，对远程医疗用户与未接触远程医疗用户进行倾向评分匹配。采用广义估计方程，比较两组患者在2020年3月14日以后亲自或远程医疗门诊就诊前12个月至就诊后3个月期间各种卫生保健服务的月使用情况。匹配后，共识别出11,131对远程医疗和未接触的患者(49%为男性;平均年龄78.9岁，标准差12.0岁)。所有患者就诊前与就诊后的卫生服务使用量均显著减少。与远程医疗组相比，未接触组的CHF住院(高频用户与低频率用户的斜率之比为1.02,95% CI 1.02-1.03)、心血管住院(1.03,95% CI 1.02-1.04)、任何原因住院(1.03,95% CI 1.02-1.04)、任何原因急诊就诊(1.03,95% CI 1.03-1.04)、任何心脏病医生就诊(1.01,95% CI 1.02- 1.02)、诊断检查(1.04,95% CI 1.03-1.05)、 and new prescriptions (1.02, 95% CI 1.01-1.03). However, the decline in primary care visit rates was steeper among telemedicine patients than among unexposed patients (ratio of slopes 0.99, 95% CI 0.99-1.00). Conclusions: Overall health care usage over time appeared higher among telemedicine users than among low-frequency users or nonusers, suggesting that telemedicine was used by patients with the greatest need or that it allowed patients to have better access or continuity of care among those who received it.

家庭远程监测和诊断算法在荷兰心脏衰竭的管理:成本-效果分析

2022 - 08 - 04 - t09:45:02内

背景:心衰是一个主要的健康问题，与患者的显著发病率、死亡率和生活质量降低有关。家庭远程监测(HTM)促进了疾病体征和症状的频繁或持续评估，并已证明，它通过让患者参与自己的护理来提高依从性，并通过促进临床显著变化的早期发现来防止急诊入院。诊断算法(DAs)是一种预测数学关系，它利用广泛收集的数据来计算特定事件的可能性，并使用这个输出来对患者进行优先治疗。本研究旨在评估荷兰HTM和DA治疗心力衰竭的成本-效益。分析了三种干预措施:常规护理、HTM和HTM加DA。使用先前发表的离散事件模拟模型。根据荷兰经济评价指南进行基础案例分析。进行了敏感性、情景和信息分析的价值。特别关注的是DA在不同事件预测诊断准确性水平和不同患者亚组的成本效益。结果: HTM + DA扩展主导HTM单独，与通常护理相比，它具有确定性的增量成本-效果比为27,712欧元(研究时购买力平价的货币换算率:€1=US $1.29; further conversions are not applicable in cost-effectiveness terms) per quality-adjusted life year. The model showed robustness in the sensitivity and scenario analyses. HTM plus the DA had a 96.0% probability of being cost-effective at the appropriate €80,000 per quality-adjusted life year threshold. An optimal point for the threshold value for the alarm of the DA in terms of its cost-effectiveness was estimated. New York Heart Association class IV patients were the subgroup with the worst cost-effectiveness results versus usual care, while HTM plus the DA was found to be the most cost-effective for patients aged <65 years and for patients in New York Heart Association class I. Conclusions: Although the increased costs of adopting HTM plus the DA in the management of heart failure may seemingly be an additional strain on scarce health care resources, the results of this study demonstrate that, by increasing patient life expectancy by 1.28 years and reducing their hospitalization rate by 23% when compared with usual care, the use of this technology may be seen as an investment, as HTM plus the DA in its current form extendedly dominates HTM alone and is cost-effective compared with usual care at normally accepted thresholds in the Netherlands.

使用智能手机应用程序Myworkout GO预测次最大运动的VO2max:一种数字健康方法的验证研究

2022 - 08 - 04 - t09:30:03内

背景:在世界范围内，缺乏体育活动仍然是心血管疾病发展的最大危险因素。可穿戴设备已经成为一种流行的测量基于活动的结果的方法，并促进行为改变，以增加心肺适合度(CRF)或最大耗氧量(VO_2max)和减轻体重。然而，在测量这些变量时，确定它们的准确性是至关重要的。本研究旨在确定使用智能手机和Myworkout GO应用程序对VO次最大值预测_2max的准确性。参与者包括162名健康志愿者:58名女性和104名男性(17-73岁)。该研究包括3个实验测试，随机分为3天。用Metamax II评估一天VO_2max，参与者在跑步机上步行或跑步。另外两天，应用程序Myworkout GO在跑步机上使用标准化的高有氧强度间歇训练(HIIT)来预测VO_2max。结果:直接测量的VO_2max(平均49,SD 14 mL/kg/min)与Myworkout GO预测的VO_2max(平均50,SD 14 mL/kg/min)之间没有显著差异。直接VO值和预测VO值_2max值高度相关，R²值为0.97 (P<.001)，估计的标准误差(SEE)为2.2 mL/kg/min，无性别差异。 Conclusions: Myworkout GO accurately calculated VO_2max, with an SEE of 4.5% in the total group. The submaximal HIIT session (4 x 4 minutes) incorporated in the application was tolerated well by the participants. We present health care providers and their patients with a more accurate and practical version of health risk estimation. This might increase physical activity and improve exercise habits in the general population.

德国慢性心力衰竭患者对数字设备自我记录和研究数据的态度:横断面调查研究

2022 - 08 - 03 - t10:00:32内

近年来，在西方工业化卫生保健系统中，使用数字移动测量设备(DMMDs)进行心血管护理自我记录的情况有所增加。对于慢性心力衰竭(cHF)患者，数字自我记录在自我管理中发挥着越来越重要的作用。来自DMMDs的数据还可以集成到远程监测项目或数据密集型医学研究中，通过数据共享收集和评估患者报告的结果度量。然而，数据密集型设备的实施和数据共享给医生和患者以及数据驱动医学研究的道德治理带来了一些挑战。本研究旨在从患者的角度探讨数字设备数据在心脏病学研究中的潜力和挑战。本研究的主要研究问题涉及到cHF患者对使用数字设备进行自我记录、共享这些数据和同意为研究目的共享数据收集的健康相关数据的态度。2020年(3月至7月)，在德国一所大学医学中心(N=159)对心脏病学研究的患者进行了横断面调查。符合条件的参与者是在该中心患有cHF的讲德语的成年患者。一份手写的调查问卷通过邮件寄出。大多数参与者(77/105,73.3%)认可数字文档，因为他们希望设备数据能帮助他们更客观地观察自己的身体及其功能。 Digital device data were believed to provide cognitive support, both for patients’ self-assessment and doctors’ evaluation of their patients’ current health condition. Interestingly, positive attitudes toward DMMD data providing cognitive support were, in particular, voiced by older patients aged >65 years. However, approximately half of the participants (56/105, 53.3%) also reported difficulty in dealing with self-documented data that lay outside the optimal medical target range. Furthermore, our findings revealed preferences for the self-management of DMMD data disclosed for data-intensive medical research among German patients with cHF, which are best implemented with a dynamic consent model. Conclusions: Our findings provide potentially valuable insights for introducing DMMD in cardiovascular research in the German context. They have several practical implications, such as a high divergence in attitudes among patients with cHF toward different data-receiving organizations as well as a large variance in preferences for the modes of receiving information included in the consenting procedure for data sharing for research. We suggest addressing patients’ multiple views on consenting and data sharing in institutional normative governance frameworks for data-intensive medical research.

在DIAPAsOn研究中，使用数字技术工具来表征心肌后或高甘油三酯患者对处方级-3多不饱和脂肪酸治疗的依从性:前瞻性观察性研究

2022 - 07 - 25 - t09:30:02内

背景:为优化慢性非传染性疾病(如动脉粥样硬化性血管疾病)的管理，保持持续坚持用药是一项证据充分的治疗挑战。目的:DIAPAsOn研究是在俄罗斯联邦进行的一项为期6个月的多中心前瞻性观察研究，研究了2167例近期有心肌梗死或内源性高甘油三酯血症的成年患者对高纯化-3多不饱和脂肪酸制剂(Omacor)的依从性。DIAPAsOn的一个特点是使用定制的电子患者参与和数据收集系统来监测依从性。在门诊就诊时也通过询问来监测依从性。该研究的目的和方法的完整描述出现在JMIR研究协议中。总脂蛋白胆固醇和低密度脂蛋白胆固醇较基线的净平均降低约为1 mmol/L，高密度脂蛋白胆固醇的净平均增加为0.2 (SD 0.53) mmol/L (P<与基线相比，所有结果为001)。探访1时平均甘油三酯水平为3.0 (SD 1.3) mmol/L，探访2时为2.0 (SD 0.9) mmol/L，探访3时为1.7 (SD 0.7) mmol/L (P<)。甘油三酯水平为<1.7 mmol/L的患者比例从基线时的13.1%(282/2151)上升到研究结束时的54%(1028/1905)。8.3%(180/2167)的患者注册了坚持治疗的数字报告;平均分数表明依从性差。 However, a clinic-based enquiry suggested high levels of adherence. Data on health-related quality of life accrued from digitally engaged patients identified improvements among patients reporting high adherence to study treatment, but patient numbers were small. Conclusions: The lipid and lipoprotein findings indicate that Omacor had nominally favorable effects on the blood lipid profile. Less than 10% of patients enrolled in DIAPAsOn used the bespoke digital platform piloted in the study, and the level of self-reported adherence to medication by these patients was also low. Reasons for this low uptake and adherence are unclear. Better adherence was recorded in clinical reports. Trial Registration: ClinicalTrials.gov NCT03415152; https://clinicaltrials.gov/ct2/show/NCT03415152

运动作为心血管疾病预防的药物:初级保健中高危患者身体活动促进干预的试点可行性研究

2022 - 06 - 29 - t09:15:03内

背景:体育活动(PA)可以降低心血管疾病(CVD)的风险因素，尽管初级保健环境提供了很大的促进PA和降低CVD风险的范围，但初级卫生保健专业人员在实践中可能缺乏自我效能感和有效促进PA的工具。运动作为心血管疾病预防的药物是一套2基于理论，基于网络的行为干预措施，一个针对卫生保健专业人员，一个针对患者，这可能提供了在初级保健中促进PA和降低心血管疾病风险的途径。目的:本研究旨在探讨运动作为预防心血管疾病药物的可行性和可能的效果。方法:这项非随机试点研究招募了来自英格兰东北部初级保健组织的参与者。注册的卫生保健专业人员参加了基于理论、基于网络的PA咨询和动机性访谈技巧课程。课程结束后，卫生保健专业人员提供基于动机性访谈的行为改变咨询，对10年内患心血管疾病风险高达20%的不活跃个体进行咨询。然后让患者访问一个基于自我决定和自我调节理论的网站，该网站旨在提高PA水平。在基线和3个月后评估结果，并在多重归责数据集中以意向治疗为基础分析患者数据。结果:初级保健组织的招聘率低于预期。来自3个注册的初级保健组织的11名卫生保健专业人员完成了网络课程，并报告了实践中PA提升的重要理论决定因素的增加(例如，自我效能，Cohen d=1.24, 95% CI 0.67-1.80; and planning, Cohen d=0.85, 95% CI −0.01 to 1.69). A total of 83 patients were enrolled in the study, and 58 (70%) completed both the baseline and 3-month assessments. Compared with baseline, patients had higher levels of objective (Cohen d=0.77, 95% CI 0.13-1.41) but not subjective (Cohen d=0.40, 95% CI −0.03 to 0.83) moderate to vigorous PA at 3 months. Patients also reported higher levels of the PA determinants of intention, self-efficacy, intrinsic motivation, and action planning and action control at 3 months (effect sizes ranged from Cohen d=0.39 to 0.60). Conclusions: The Movement as Medicine for CVD Prevention intervention seems to have the potential to improve patient PA behaviors and important determinants of health care professionals’ PA promotion practices. However, the recruitment rates of primary care organizations in this study were low and would need to be increased to examine the efficacy of the program. This study offers several insights into improving the feasibility of this primary care PA promotion pathway. Trial Registration: ISRCTN Registry ISRCTN14582348; http://www.isrctn.com/ISRCTN14582348