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E-Bulletin No. 4 - May 2022 | Digital Health and Cardiovascular Disease

Published on: 25 May 2022 Viewed: 275

Connected Health (CH) is planning a special issue regarding "Telemedicine in the Cardiovascular World: Ready for the Future?". The special issue will provide up-to-date, evidence-based literature, as well as expert-guided practice to understand the current status of digital health application in cardiovascular medicine, different advanced technical procedures, and future development of this field.
It could be seen that digital health is a helpful tool for patients with cardiovascular disease. Many experts published related articles on this topic, so we have highlighted some quality articles as follows:

Title: Bedtime versus morning use of antihypertensives for cardiovascular risk reduction (BedMed): protocol for a prospective, randomised, open-label, blinded end-point pragmatic trial
Authors: Scott R Garrison, Michael R Kolber, G Michael Allan, Jeffrey Bakal, Lee Green, Alexander Singer, Darryl R Trueman, Finlay A McAlister, Raj S Padwal, Michael D Hill, Braden Manns, Kimberlyn McGrail, Braden O'Neill, Michelle Greiver, Liesbeth S Froentjes, Donna P Manca, Dee Mangin, Sabrina T Wong, Cathy MacLean, Jessica EM Kirkwood, Rita McCracken, James P McCormack, Colleen Norris, and Tina Korownyk
Type: Original Article
Introduction: Sleep-time blood pressure correlates more strongly with adverse cardiovascular events than does daytime blood pressure. The BedMed trial evaluates whether bedtime antihypertensive administration, as compared with conventional morning use, reduces major adverse cardiovascular events.
Methods and analysis:
Design: Prospective randomised, open-label, blinded end-point trial.
Participants: Hypertensive primary care patients using blood pressure lowering medication and free from glaucoma.
Setting: Community primary care providers in 5 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba and Ontario) are mailing invitations to their eligible patients. Social media campaigns (Google, Facebook) are additionally running in the same provinces.
Intervention: Consenting participants are allocated via central randomisation to bedtime vs morning use of all antihypertensives.
Follow-up: (1) Telephone or email questionnaire at 1 week, 6 weeks, 6 months and every 6 months thereafter, and (2) accessing linked governmental healthcare databases tracking hospital and community medical services.
Primary outcome: Composite of all-cause death, or hospitalisation for myocardial infarction/acute-coronary syndrome, stroke or congestive heart failure.
Secondary outcomes: Each primary outcome element on its own, all-cause hospitalisation or emergency department visit, long-term care admission, non-vertebral fracture, new glaucoma diagnosis, 18-month cognitive decline from baseline (via Short Blessed Test).
Select other outcomes: Self-reported nocturia burden at 6 weeks and 6 months (no, minor or major burden), 1-year self-reported overall health score (EQ-5D-5L), self-reported falls, total cost of care (acute and community over study duration) and mean sleep-time systolic blood pressure after 6 months (via 24-hour monitor in a subset of 302 sequential participants).
Primary outcome analysis: Cox proportional hazards survival analysis.
Sample size: The trial will continue until a projected 254 primary outcome events have occurred.
Current status: Enrolment ongoing (3227 randomised to date).
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Title: STEP to estimate cardiovascular events by home blood pressure in the era of digital hypertension
Authors: Kazuomi Kario, Atsushi Sakima, and Yusuke Ohya
Type: Editorial
Abstract: Recently, the STEP trial (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) clearly demonstrated that intensive treatment with a systolic blood pressure (BP) target of 110-130 mmHg resulted in a lower incidence of cardiovascular events than standard treatment with a systolic BP target of 130-150 mmHg in older patients with hypertension. The target BP in older hypertensive patients is controversial and varies among the different guidelines for hypertension management. In the STEP trial, adjustment of antihypertensive medication was based on office BP, and a successful adjustment was considered to be one that resulted in a difference of 9.3 mmHg between the intensive treatment and standard treatment groups. In the STEP trial, it was clinically important that the home BP monitoring be used to evaluate the BP control. The average difference in morning home systolic BP between the intensive and standard management groups was around 7.5 mmHg. As a result, all the cardiovascular events, including stroke, coronary artery disease, and heart failure, were markedly suppressed in the intensive BP management group. The benefit to patients with heart failure was greatest, with a hazard ratio of 0.27.
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Title: Smartphone Ownership and Interest in Mobile Health Technologies for Self-care Among Patients With Chronic Heart Failure: Cross-sectional Survey Study
Authors: Jonathan W Leigh, Ben S Gerber, Christopher P Gans, Mayank M Kansal, and Spyros Kitsiou
Type: Original Article
Background: Heart failure (HF) is a highly prevalent chronic condition that places a substantial burden on patients, families, and health care systems worldwide. Recent advances in mobile health (mHealth) technologies offer great opportunities for supporting many aspects of HF self-care. There is a need to better understand patients’ adoption of and interest in using mHealth for self-monitoring and management of HF symptoms.
Objective: The purpose of this study is to assess smartphone ownership and patient attitudes toward using mHealth technologies for HF self-care in a predominantly minority population in an urban clinical setting.
Methods: We conducted a cross-sectional survey of adult outpatients (aged ≥18 years) at an academic outpatient HF clinic in the Midwest. The survey comprised 34 questions assessing patient demographics, ownership of smartphones and other mHealth devices, frequently used smartphone features, use of mHealth apps, and interest in using mHealth technologies for vital sign and HF symptom self-monitoring and management.
Results: A total of 144 patients were approached, of which 100 (69.4%) participated in the study (63/100, 63% women). The participants had a mean age of 61.3 (SD 12.25) years and were predominantly Black or African American (61/100, 61%) and Hispanic or Latino (18/100, 18%). Almost all participants (93/100, 93%) owned a cell phone. The share of patients who owned a smartphone was 68% (68/100). Racial and ethnic minorities that identified as Black or African American or Hispanic or Latino reported higher smartphone ownership rates compared with White patients with HF (45/61, 74% Black or African American and 11/18, 61% Hispanic or Latino vs 9/17, 53% White). There was a moderate and statistically significant association between smartphone ownership and age (Cramér V [ΦC]=0.35; P<.001), education (ΦC=0.29; P=.001), and employment status (ΦC=0.3; P=.01). The most common smartphone features used by the participants were SMS text messaging (51/68, 75%), internet browsing (43/68, 63%), and mobile apps (41/68, 60%). The use of mHealth apps and wearable activity trackers (eg, Fitbits) for self-monitoring of HF-related parameters was low (15/68, 22% and 15/100, 15%, respectively). The most popular HF-related self-care measures participants would like to monitor using mHealth technologies were physical activity (46/68, 68%), blood pressure (44/68, 65%), and medication use (40/68, 59%).
Conclusions: Most patients with HF have smartphones and are interested in using commercial mHealth apps and connected health devices to self-monitor their condition. Thus, there is a great opportunity to capitalize on the high smartphone ownership among racial and ethnic minority patients to increase reach and enhance HF self-management through mHealth interventions.
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Title: Remote Screening for Atrial Fibrillation by a Federal Cardiac Monitoring System in Primary Care Patients in Russia: Results from the Prospective Interventional Multicenter FECAS-AFS Study
Authors: Daria Gognieva, Nelly Vishnyakova, Yulia Mitina, Petr Chomakhidze, Dinara Mesitskaya, Natalia Kuznetsova, Mohamed Khiari, Galina Ryabykina, Sergey Boytsov, Abram Syrkin, Hugo Saner, and Philipp Kopylov
Type: Original Article
Background: Screening for atrial fibrillation has the potential to significantly reduce cardiovascular morbidity and mortality. However, questions in regard to how to screen, on whom to screen, and the optimal setting of screening remain unanswered.
Objective: To assess the applicability of a federal cardiac monitoring for atrial fibrillation (AF) screening and remote heart rhythm monitoring in patients at high cardiovascular risk in a mixed urban and rural population in Russia.
Methods: This is a prospective multicenter cohort study including 3249 individuals with high cardiovascular risk (mean age 56 ± 12.8 years) from the larger Moscow region who were screened for AF using a smartphone-case based single-lead ECG monitor over a period of 18 month. The endpoints were considered as number of newly diagnosed AF; mean time to diagnosis; number of patients for the first time assigned to anticoagulation therapy; frequency of adverse events.
Results: A trial fibrillation was diagnosed in 126 patients, 36 of them for the first time. The mean time to diagnosis was 3 ± 2 days. Of 36 patients, the CHA2DS2-VASc score was ≥1 in 34 cases, ≥2 in 29 cases. Anticoagulant therapy was first induced in 31 patients. One death in newly diagnosed group and two deaths in chronic group were registered. There were a total of eight hospitalizations: one in newly diagnosed and seven in chronic AF patients.
Conclusion: Our results indicate that a Federal AF screening system in patients at high cardiovascular risk by using a smartphone-case based single lead ECG which is supported by centrally located ECG specialist and central data management is feasible and reliable when performed in a mixed urban and rural area. Further studies are needed to evaluate the full potential of this approach.
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Title: Estimation of Changes in Intracardiac Hemodynamics Using Wearable Seismocardiography and Machine Learning in Patients with Heart Failure: A Feasibility Study
Authors: Md Mobashir Hasan Shandhi, Joanna Fan, James Heller, Mozziyar Etemadi, Liviu Klein, and Omer Inan
Type: Original Article
Objective: Tracking changes in hemodynamic congestion and the consequent proactive readjustment of treatment has shown efficacy in reducing hospitalizations for patients with heart failure (HF). However, the cost-prohibitive nature of these invasive sensing systems precludes their usage in the large patient population affected by HF. The objective of this research is to estimate the changes in pulmonary artery mean pressure (PAM) and pulmonary capillary wedge pressure (PCWP) following vasodilator infusion during right heart catheterization (RHC), using changes in simultaneously recorded wearable seismocardiogram (SCG) signals captured with a small wearable patch.
Methods: A total of 20 patients with HF (20% women, median age 55 (interquartile range (IQR), 44-64) years, ejection fraction 24 (IQR, 16-43)) were fitted with a wearable sensing patch and underwent RHC with vasodilator challenge. We divided the dataset randomly into a trainingtesting set (n=15) and a separate validation set (n=5). We developed globalized (population) regression models to estimate changes in PAM and PCWP from the changes in simultaneously recorded SCG.
Results: The regression model estimated both pressures with good accuracies: root-mean-square-error (RMSE) of 2.5 mmHg and R2 of 0.83 for estimating changes in PAM, and RMSE of 1.9 mmHg and R2 of 0.93 for estimating changes in PCWP for the training-testing set, and RMSE of 2.7 mmHg and R2 of 0.81 for estimating changes in PAM, and RMSE of 2.9 mmHg and R2 of 0.95 for estimating changes in PCWP for the validation set respectively.
Conclusion: Changes in wearable SCG signals may be used to track acute changes in intracardiac hemodynamics in patients with HF.
Significance: This method holds promise in tracking longitudinal changes in hemodynamic congestion in hemodynamically-guided remote home monitoring and treatment for patients with HF.
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Moreover, there was also NEWS about the related topic in the scientific circles:
FDA intensified its approval on wearable electrocardiogram device, and more COVID-19 considerations on the cardiology, all promote the increasing need for remote monitoring of cardiovascular disease;
(, last access: 23 May 2022).
Australia's Extended Medicare Safety Net (EMSN) will apply an EMSN cap to attendance items, coronavirus (COVID-19) telehealth items and one cardiac item; (, last access: 23 May 2022).
Bill Taranto, founding partner and president of Merck Global Health Innovation Fund, said that entrepreneurs and investors will expand telemedicine into more chronic care spaces like cardiology in 2022;
(, last access: 23 May 2022).

We hope our sharing will inspire you. Looking forward to meeting you next time in CH Bulletin.

Respectfully submitted by the Editorial Office of Connected Health
Written by Abby Zhang
Assistant Editor of Connected Health

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