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Open accessJournal ArticleDOI: 10.1038/S41569-021-00522-7

Smart wearable devices in cardiovascular care: where we are and how to move forward.

04 Mar 2021-Nature Reviews Cardiology (Nature Publishing Group)-Vol. 18, Iss: 8, pp 581-599
Abstract: Technological innovations reach deeply into our daily lives and an emerging trend supports the use of commercial smart wearable devices to manage health. In the era of remote, decentralized and increasingly personalized patient care, catalysed by the COVID-19 pandemic, the cardiovascular community must familiarize itself with the wearable technologies on the market and their wide range of clinical applications. In this Review, we highlight the basic engineering principles of common wearable sensors and where they can be error-prone. We also examine the role of these devices in the remote screening and diagnosis of common cardiovascular diseases, such as arrhythmias, and in the management of patients with established cardiovascular conditions, for example, heart failure. To date, challenges such as device accuracy, clinical validity, a lack of standardized regulatory policies and concerns for patient privacy are still hindering the widespread adoption of smart wearable technologies in clinical practice. We present several recommendations to navigate these challenges and propose a simple and practical 'ABCD' guide for clinicians, personalized to their specific practice needs, to accelerate the integration of these devices into the clinical workflow for optimal patient care.

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Topics: Wearable technology (59%), Wearable computer (55%)
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21 results found


Open accessJournal ArticleDOI: 10.1016/J.METABOL.2021.154838
Jae-Seung Yun1, Seung Hyun Ko1Institutions (1)
Abstract: With the advances in diabetes care, the trend of incident cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM) has been decreasing over past decades. However, given that CVD is still a major cause of death in patients with diabetes and that the risk of CVD in patients with T2DM is more than twice that in those without DM, there are still considerable challenges to the prevention of CVD in diabetes. Accordingly, there have been several research efforts to decrease cardiovascular (CV) risk in T2DM. Large-scale genome-wide association studies (GWAS) and clinical cohort studies have investigated the effects of factors, such as genetic determinants, hypoglycaemia, and insulin resistance, on CVD and can account for the unexplained CV risk in T2DM. Lifestyle modification is a widely accepted cornerstone method to prevent CVD as the first-line strategy in T2DM. Recent reports from large CV outcome trials have proven the positive CV effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in patients with high CVD risk. Overall, current practice guidelines for the management of CVD in T2DM are moving from a glucocentric strategy to a more individualised patient-centred approach. This review will discuss the current epidemiologic trends of CVD in T2DM and the risk factors linking T2DM to CVD, including genetic contribution, hypoglycaemia, and insulin resistance, and proper care strategies, including lifestyle and therapeutic approaches.

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1 Citations


Open accessPosted ContentDOI: 10.1101/2021.07.23.21261052
M. Erickson1, K. Wang2, J. Counts2, Leanne M. Redman3  +4 moreInstitutions (3)
29 Jul 2021-medRxiv
Abstract: Night shift work, characterized by behavioral circadian disruption, increases cardiometabolic disease risk. Our long-term goal is to develop a novel methodology to quantify behavioral circadian disruption in field-based settings and to explore relations to four metabolic salivary biomarkers of circadian rhythm. This pilot study enrolled 36 police academy trainees to test the feasibility of using wearable activity trackers to assess changes in behavioral patterns. Using a two-group observational study design, participants completed in-class training during dayshift for six weeks followed by either dayshift or nightshift field-training for six weeks. We developed a novel data-post processing step that improves sleep detection accuracy of sleep episodes that occur during daytime. We next assessed changes to resting heart rate (RHR) and sleep regularity index (SRI) during dayshift versus nightshift field training. Secondarily, we examined changes in field-based assessments of salivary cortisol, uric acid, testosterone, and melatonin during dayshift versus nightshift. Compared to dayshift, nightshift workers experienced larger changes to resting heart rate, sleep regularity index (indicating reduced sleep regularity), and alternations to sleep/wake activity patterns accompanied by blunted salivary cortisol. Salivary uric acid, testosterone, and melatonin did not change. These findings show that nightshift work--a form of behavioral circadian rhythm disruption--was detectable in police trainees using activity trackers alone and in combination with a specialized data analysis methodology. KEY POINTSO_LINight shift work increases cardiometabolic disease risk and this may be a consequence of behavioral circadian misalignment. C_LIO_LITo advance this hypothesis, methodologies to quantify behavioral irregularities during nightshift in field-based settings are needed. C_LIO_LIIn this pilot study, commercially available activity trackers combined with a novel data processing step were used to assess alterations in sleep/wake patterns in police trainees during dayshift versus nightshift. C_LIO_LIWe also explored relations with four metabolic salivary biomarkers of circadian rhythm during dayshift versus nightshift. C_LIO_LICompared to dayshift, nightshift resulted in larger perturbations of resting heart rate, sleep regularity index (indicating reduced regularity), and alterations in sleep and activity patterns; this was accompanied by blunted cortisol. C_LIO_LIThis novel data processing step extends commercially available technology for successful application in real-world shift work settings. C_LI

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Topics: Shift work (54%), Circadian rhythm (53%)

1 Citations


Open accessJournal ArticleDOI: 10.3390/S21093122
Soonil Kwon1, So Ryoung Lee1, Eue Keun Choi2, Eue Keun Choi1  +5 moreInstitutions (2)
30 Apr 2021-Sensors
Abstract: There are few reports on head-to-head comparisons of electrocardiogram (ECG) monitoring between adhesive single-lead and Holter devices for arrhythmias other than atrial fibrillation (AF). This study aimed to compare 24 h ECG monitoring between the two devices in patients with general arrhythmia. Twenty-nine non-AF patients with a workup of pre-diagnosed arrhythmias or suspicious arrhythmic episodes were evaluated. Each participant wore both devices simultaneously, and the cardiac rhythm was monitored for 24 h. Selective ECG parameters were compared between the two devices. Two cardiologists independently compared the diagnoses of each device. The two most frequent monitoring indications were workup of premature atrial contractions (41.4%) and suspicious arrhythmia-related symptoms (37.9%). The single-lead device had a higher noise burden than the Holter device (0.04 ± 0.05% vs. 0.01 ± 0.01%, p = 0.024). The number of total QRS complexes, ventricular ectopic beats, and supraventricular ectopic beats showed an excellent degree of agreement between the two devices (intraclass correlation coefficients = 0.991, 1.000, and 0.987, respectively). In addition, the minimum/average/maximum heart rates showed an excellent degree of agreement. The two cardiologists made coherent diagnoses for all 29 participants using both monitoring methods. In conclusion, the single-lead adhesive device could be an acceptable alternative for ambulatory ECG monitoring in patients with general arrhythmia.

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Topics: Premature atrial contraction (56%), Atrial fibrillation (54%), QRS complex (51%) ... read more

Open accessJournal ArticleDOI: 10.1093/EHJDH/ZTAB055
Abhinav Sharma1, Abhinav Sharma2, Emily Oulousian2, Emily Oulousian1  +10 moreInstitutions (5)
30 Sep 2021-
Abstract: Abstract Aims Artificial intelligence (A.I) driven voice-based assistants may facilitate data capture in clinical care and trials; however, the feasibility and accuracy of using such devices in a healthcare environment are unknown. We explored the feasibility of using the Amazon Alexa (‘Alexa’) A.I. voice-assistant to screen for risk-factors or symptoms relating to SARS-CoV-2 exposure in quaternary care cardiovascular clinics. Methods We enrolled participants to be screened for signs and symptoms of SARS-CoV-2 exposure by a healthcare provider and then subsequently by the Alexa. Our primary outcome was interrater reliability of Alexa to healthcare provider screening using Cohen’s Kappa statistic. Participants rated the Alexa in a post-study survey (scale of 1 to 5 with 5 reflecting strongly agree). This study was approved by the McGill University Health Centre ethics board. Results We prospectively enrolled 215 participants. The mean age was 46 years (17.7 years standard deviation [SD]), 55% were female, and 31% were French speakers (others were English). In total, 645 screening questions were delivered by Alexa. The Alexa mis-identified one response. The simple and weighted Cohen’s kappa statistic between Alexa and healthcare provider screening was 0.989 (95% CI: 0.982, 0.997) and 0.992 (955 CI 0.985, 0.999) respectively. The participants gave an overall mean rating of 4.4 (out of 5, 0.9 SD). Conclusion Our study demonstrates the feasibility of an A.I. driven multilingual voice-based assistant to collect data in the context of SARS-CoV-2 exposure screening. Future studies integrating such devices in cardiovascular healthcare delivery and clinical trials are warranted. Registration https://clinicaltrials.gov/ct2/show/NCT04508972

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Open accessJournal ArticleDOI: 10.1016/J.CJCA.2021.11.014
Abstract: While COVID-19 is still ongoing and responsible for over 5 million deaths, the scope and speed of advances over the last year in terms of scientific discovery, data dissemination and technology have been staggering. It is not a matter of “if” but “when” we will face the next pandemic; how we leverage technology and data management effectively to create flexible ecosystems that facilitate collaboration, equitable care, and innovation will determine the severity and scale. The aim of this review is to address emerging challenges that came to light during the pandemic in healthcare and innovations that enabled us to adapt and continue to care for patients. The pandemic highlighted the need for seismic shifts in care paradigms and technology with considerations related to the digital divide and health literacy for digital health (DH) interventions to reach full potential and improve health outcomes. We discuss advances in telemedicine, remote patient monitoring (RPM), and emerging wearable technologies. Despite the promise of DH, we emphasize the importance of addressing its limitations including interpretation challenges, accuracy of findings, artificial intelligence driven algorithms. We summarize the most recent recommendation of the Virtual Care Task Force to scaling virtual medical services in Canada. Finally, we propose a model for optimal implementation of health digital innovations with 5 tenets including Data Management, Data Security, Digital Biomarkers, Useful Artificial Intelligence and Clinical Integration.

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Topics: Digital health (60%), Health care (54%), Telemedicine (54%) ... read more

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106 results found


Open accessJournal ArticleDOI: 10.1093/EUROPACE/EUW295
Paulus Kirchhof, Stefano Benussi1, Dipak Kotecha2, Anders Ahlsson3  +46 moreInstitutions (4)
01 Nov 2016-Europace
Abstract: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC Endorsed by the European Stroke Organisation (ESO)

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4,765 Citations




Journal ArticleDOI: 10.1016/J.JACC.2017.11.006
Abstract: Glenn N. Levine, MD, FACC, FAHA, Chair Patrick T. O’Gara, MD, MACC, FAHA, Chair-Elect Jonathan L. Halperin, MD, FACC, FAHA, Immediate Past Chair Sana M. Al-Khatib, MD, MHS, FACC, FAHA Joshua A. Beckman, MD, MS, FAHA Kim K. Birtcher, MS, PharmD, AACC Biykem Bozkurt, MD, PhD, FACC, FAHA

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2,467 Citations


Journal ArticleDOI: 10.1016/S0140-6736(11)60101-3
19 Feb 2011-The Lancet
Abstract: Summary Background Results of previous studies support the hypothesis that implantable haemodynamic monitoring systems might reduce rates of hospitalisation in patients with heart failure. We undertook a single-blind trial to assess this approach. Methods Patients with New York Heart Association (NYHA) class III heart failure, irrespective of the left ventricular ejection fraction, and a previous hospital admission for heart failure were enrolled in 64 centres in the USA. They were randomly assigned by use of a centralised electronic system to management with a wireless implantable haemodynamic monitoring (W-IHM) system (treatment group) or to a control group for at least 6 months. Only patients were masked to their assignment group. In the treatment group, clinicians used daily measurement of pulmonary artery pressures in addition to standard of care versus standard of care alone in the control group. The primary efficacy endpoint was the rate of heart-failure-related hospitalisations at 6 months. The safety endpoints assessed at 6 months were freedom from device-related or system-related complications (DSRC) and freedom from pressure-sensor failures. All analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00531661. Findings In 6 months, 84 heart-failure-related hospitalisations were reported in the treatment group (n=270) compared with 120 in the control group (n=280; rate 0·32 vs 0·44, hazard ratio [HR] 0·72, 95% CI 0·60–0·85, p=0·0002). During the entire follow-up (mean 15 months [SD 7]), the treatment group had a 37% reduction in heart-failure-related hospitalisation compared with the control group (158 vs 254, HR 0·63, 95% CI 0·52–0·77; p Interpretation Our results are consistent with, and extend, previous findings by definitively showing a significant and large reduction in hospitalisation for patients with NYHA class III heart failure who were managed with a wireless implantable haemodynamic monitoring system. The addition of information about pulmonary artery pressure to clinical signs and symptoms allows for improved heart failure management. Funding CardioMEMS.

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Topics: Heart failure (57%), Ejection fraction (55%), Randomized controlled trial (52%) ... read more

1,083 Citations


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