Abstract Background Chronic heart failure (CHF) remains a common cause of disability, death and hospital admission. Several investigations support the usefulness of programs of disease management for ...improving clinical outcomes. However, the effect of home-based telemanagement programs on the rate of hospital readmission is still unclear and the cost-effectiveness ratio of such programs is unknown. The aim of the study was to determine whether a home-based telemanagement (HBT) programme in CHF patients decreased hospital readmissions and hospital costs in comparison with the usual care (UC) follow-up programme over a one-year period. Methods and results Four hundred-sixty CHF patients (pts), aged 57 ± 10 years were randomised to two management strategies: 230 pts to HBT programme and 230 pts to UC programme. The HBT pts received a portable device, transferring, by telephone, a one-lead trace to a receiving station where a nurse was available for interactive teleconsultation. The UC pts were referred to their primary care physicians and cardiologists. The primary objective of the study was one-year hospital readmission for cardiovascular reasons. During one-year follow-up 55 pts (24%) in HBT group and 83 pts (36%) in UC group had at least one readmission (RR = 0.56; 95% CI: 0.38–0.82; p = 0.01). After adjusting for clinical and demographic characteristics, the HBT group had a significantly lower risk of readmission compared with the UC group (HR = 0.50, 95% CI: 0.34–0.73; p = 0.01). The intervention was associated with a 36% decrease in the total number of hospital readmissions (HBT group: 91 readmissions; UC group: 142 readmissions) and a 31% decrease in the total number of episodes of hemodynamic instability (101 in HBT group vs 147 in UC group). The rate of hearth failure-related readmission was 19% (43 pts) in HBT group and 32% (73 pts) in UC group (RR = 0.49, 95% CI: 0.31–0.76; p = 0.0001). No significant difference was found on cardiovascular mortality between groups. Mean cost for hospital readmission was significantly lower in HBT group (€ 843 +/− 1733) than in UC group (€ 1298 +/− 2322), (− 35%, p < 0.01). Conclusions This study suggests that one-year HBT programme reduce hospital readmissions and costs in CHF patients.
Aims
To evaluate the impact of Home Monitoring™ (HM) technology on detection and treatment of atrial fibrillation (AF).
Methods and results
One hundred and sixty-six patients (mean age 73 ± 10 years, ...112 males) received HM devices 121 pacemakers, 22 implantable cardioverter defibrillators (ICDs), and 23 ICDs combined with cardiac resynchronization therapy. A nurse consulted the cardioreports on the website and submitted the alerts for AF (new onset AF, persistent AF, and AF burden of >10% for >5 consecutive days) to the physician. During a mean follow-up of 488 ± 203 days, 42 patients (26%) had alerts for AF. Twenty-two patients had no history of AF before implant. In nine patients, no further action was taken. For the remaining 33 patients, an unscheduled follow-up was performed: in 16, antiarrhythmic drug therapy was introduced/modified; in 15, anticoagulation was started; in 2, antiplatelet drugs were introduced; in 7, an external cardioversion was performed; in 2 patients, the device was reprogrammed to avoid intermittent atrial undersensing during AF; and in 4 patients, no further action was taken. In four cases the arrhythmia was not confirmed (false positive). The median time to the first intervention for AF was 50 days (148 days before the scheduled follow-up).
Conclusion
The HM technology allowed early detection of AF in paced patients and early reaction to optimize medical treatment.
Purpose
To better understand opportunities and barriers to implementation and adoption, this mixed‐methods study qualitatively examined attitudes toward telecardiology services among veterans who use ...in‐person (IP) outpatient cardiology service versus those using telecardiology (TC) outpatient services.
Methods
Free‐text responses were collected from N = 179 veterans enrolled in Veteran Health Administration (VHA) IP or TC services in 3 rural‐serving, outpatient telehealth clinics and 1 large, metropolitan outpatient center. Mixed‐method analyses of responses included thematic analysis, followed by comparison of code categories and themes between IP and TC groups.
Findings
Fifteen thematic coding categories were identified, which comprised 4 valence categories (favorable or unfavorable attitudes toward TC and IP), as well as themes pertaining to obstacles and opportunities for TC implementation. Overall, veterans enrolled in TC held more favorable attitudes toward TC than those enrolled in IP. Veteran responses included structural concerns (eg, time demands, access, and travel), as well as humanistic qualities (rapport, competence, and face‐to‐face contact). Differences were observed between the responses of veterans who reported dwelling in urban, suburban, and rural communities, with rural‐identifying veterans generally holding more favorable attitudes toward TC than suburban‐identifying veterans.
Conclusions
TC users had overwhelmingly positive perceptions of TC. Conversely, unfavorable attitudes from IP patients toward TC did not appear to be borne out in the responses of TC users. On the contrary, TC users’ responses may indicate opportunities for allaying the concerns of TC‐naïve veterans. This suggests promise for developing tailored education to dispel barriers for TC service implementation.
Telecardiology in Rural Practice: Global Trends Yamano, Takashi; Kotani, Kazuhiko; Kitano, Naomi ...
International journal of environmental research and public health,
04/2022, Letnik:
19, Številka:
7
Journal Article
Recenzirano
Odprti dostop
The management of cardiovascular diseases in rural areas is plagued by the limited access of rural residents to medical facilities and specialists. The development of telecardiology using information ...and communication technology may overcome such limitation. To shed light on the global trend of telecardiology, we summarized the available literature on rural telecardiology. Using PubMed databases, we conducted a literature review of articles published from January 2010 to December 2020. The contents and focus of each paper were then classified. Our search yielded nineteen original papers from various countries: nine in Asia, seven in Europe, two in North America, and one in Africa. The papers were divided into classified fields as follows: seven in tele-consultation, four in the telemedical system, four in the monitoring system, two in prehospital triage, and two in tele-training. Six of the seven tele-consultation papers reported the consultation from rural doctors to urban specialists. More reports of tele-consultations might be a characteristic of telecardiology specific to rural practice. Further work is necessary to clarify the improvement of cardiovascular outcomes for rural residents.
In this paper, several simple and efficient sign and error nonlinearity-based adaptive filters, which are computationally superior having multiplier free weight update loops are used for cancellation ...of noise in electrocardiographic (ECG) signals. The proposed implementation is suitable for applications such as biotelemetry, where large signal to noise ratios with less computational complexity are required. These schemes mostly employ simple addition, shift operations and achieve considerable speed up over the other least mean square (LMS)-based realizations. Simulation studies shows that the proposed realization gives better performance compared to existing realizations in terms of signal-to-noise ratio and computational complexity.
Heart murmur evaluation is the most common cause of referral to cardiology, and auscultation of heart sounds with a stethoscope remains a key component of the initial cardiovascular exam. Adoption of ...telecardiology has been limited by challenges in teleauscultation. We set out to compare in-person auscultatory findings with heart sounds recorded by the Core stethoscope (Eko, Berkeley, CA) in patients with normal heart sounds, innocent heart murmurs, and a variety of pathologic findings. Our study demonstrates that Eko recordings had a high percent of agreement with in-person auscultation findings and echocardiogram findings, with moderate inter-rater reliability. It was useful in identifying patients with pathologic murmurs who would benefit from further assessment. It was able to discern major types of pathological murmurs. Certain qualitative differences in the recorded sounds as compared to in-person auscultation were identified by the reading cardiologists. They were able to acclimate to these subtle differences. The system was felt to be easy to use, and most cardiologists in the study would consider using it in clinical settings. The Eko Core system may be a useful screening tool for murmur evaluation.
Objectives:
Telemedicine appears to be a promising tool for healthcare professionals to deliver remote care to patients with cardiovascular diseases especially during the COVID-19 pandemic. We aimed ...in this study to evaluate the value of telemedicine added to the short-term medical care of acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI).
Methods:
Two hundred acute STEMI patients after primary PCI were randomly divided into two groups. One hundred patients in group A (study group) received a monthly videoconferencing teleconsultation using a smartphone application for 3 months starting 1 week after discharge and at least a single face-to-face (F2F) clinic visit. We reviewed in each virtual visit the symptoms of patients, adherence to healthy lifestyle measures, medications, smoking cessation, and cardiac rehabilitation. Group B (control group) included 100 patients who received at least a single F2F clinic visit in the first 3 months after discharge. Both groups were interviewed after 4 months from discharge for major adverse cardiac events (MACE), adherence to medications, smoking cessation, and cardiac rehabilitation. A survey was done to measure the satisfaction of patients with telemedicine.
Results:
There was no significant difference between both groups in MACE and their adherence to aspirin, P2Y12 inhibitor, and beta-blockers. However, group A patients had better adherence to statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, smoking cessation, and cardiac rehabilitation. Sixty-one percent of patients stated that these videoconferencing teleconsultations were as good as the clinic visits, while 87% of patients were satisfied with telemedicine.
Conclusions:
Telemedicine may provide additional benefit to the short-term regular care after primary PCI to STEMI patients through videoconferencing teleconsultations by increasing their adherence to medications and healthy lifestyle measures without a significant difference in the short-term MACE. These virtual visits gained a high level of satisfaction among the patients.
Telecardiology has the advantage of reducing patient's access time to the hemodynamics units. Data from literature show a reduction in ST-elevation myocardial infarction (STEMI) during COVID-19 ...pandemic. However, there is a low number of studies on the impact of telecardiology during the pandemic.
Our telecardiology system is composed of a Hub-and-Spoke network of hospitals and ambulances that ensures a rapid exchange of information allowing STEMI patients to be treated in the shortest time possible. We compared data from electrocardiograms (ECGs) transmissions and STEMI diagnosis collected between February and April 2020 with the data from the same period of 2019.
Despite a significant reduction of ECGs transmissions from the telecardiology network was observed, the number of diagnosed STEMI during 2020 was stable and did not show any significant difference compared to 2019. The total number of STEMI diagnosis in the months under examination during 2019 were 47 out of 7463 ECGs (0.63%), while in 2020 were 48 out of 5797 ECGs (0.83%).
The efficiency of our telecardiology system along with the low spread of the infection in our region contributed to maintaining the number of STEMI diagnosis and patient’s care in line with the past even during the pandemic.
To date, mortality rates associated with heart diseases are dangerously increasing, making them the leading cause of death globally. From this point of view, digital technologies can provide health ...systems with the necessary support to increase prevention and monitoring, and improve care delivery. The present study proposes a review of the literature to understand the state of the art and the outcomes of international experiences. A reference framework is defined to develop reflections to optimize the use of resources and technologies, favoring the development of new organizational models and intervention strategies. Findings highlight the potential significance of e-health and telemedicine in supporting novel solutions and organizational models for cardiac illnesses as a response to the requirements and restrictions of patients and health systems. While privacy concerns and technology-acceptance-related issues arise, new avenues for research and clinical practice emerge, with the need to study ad hoc managerial models according to the type of patient and disease.
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