SMARTphone-based, early cardiac REHABilitation in patients with acute coronary syndromes [SMART-REHAB Trial]: A randomized controlled trial protocol

© 2016 The Author(s). Background: There are well-documented treatment gaps in secondary prevention of coronary heart disease and no clear guidelines to assist early physical activity after acute coronary syndromes (ACS). Smartphone technology may provide an innovative platform to close these gaps. This paper describes the study design of a randomized controlled trial assessing whether a smartphone-based secondary prevention program can facilitate early physical activity and improve cardiovascular health in patients with ACS. Methods: We have developed a multi-faceted, patient-centred smartphone-based secondary prevention program emphasizing early physical activity with a graduated walking program initiated on discharge from ACS admission. The program incorporates; physical activity tracking through the smartphone's accelerometer with interactive feedback and goal setting; a dynamic dashboard to review and optimize cardiovascular risk factors; educational messages delivered twice weekly; a photographic food diary; pharmacotherapy review; and support through a short message service. The primary endpoint of the trial is change in exercise capacity, as measured by the change in six-minute walk test distance at 8-weeks when compared to baseline. Secondary endpoints include improvements in cardiovascular risk factor status, psychological well-being and quality of life, medication adherence, uptake of cardiac rehabilitation and re-hospitalizations. Discussion: This randomized controlled trial will use a smartphone-phone based secondary prevention program to emphasize early physical activity post-ACS. It will provide evidence regarding the feasibility and utility of this innovative platform in closing the treatment gaps in secondary prevention. Trial registration: The trial was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) on April 4, 2016. The registration number is ACTRN12616000426482

Cardiac Telehealth Rehabilitation: Empowering the Patient

Coronary artery disease or coronary heart disease is one of the leading causes of death in the world. Center-based cardiac rehab has long been a sustainable answer for recovery from an acute coronary event. However, the COVID-19 pandemic halted in-person appointments for cardiac rehab patients. Therefore, patients and their healthcare team met virtually. The objective of this literature review is to discover the efficacy and cost-effectiveness of cardiac telerehabilitation, as it will likely have a more prominent role in patient recovery from acute myocardial infarctions. To determine this, a literature review was conducted based on recent studies involving coronary artery disease patients in a center-based cardiac rehab and telehealth style cardiac rehab. Twenty-one articles were reviewed, and five themes were revealed. These include lifestyle modifications, secondary prevention, patient-led care and adherence, technology during COVID-19, and cost-effectiveness. From these themes, a concept map was constructed. The literature revealed no statistically significant difference in patient outcomes between telehealth-based and center-based cardiac rehab. Telehealth rehab also demonstrated cost-effectiveness in various delivery methods including telephone, short messaging services, mobile applications, and video calls. Therefore, it can be concluded that cardiac telehealth rehab can be offered as a primary option for cardiac rehab. With the common barriers to attending in person cardiac rehab including schedule, geographical barriers, and the COVID-19 pandemic, telehealth rehab offers the patient relief of some of these barriers

Norton Healthcare: A Strong Payer-Provider Partnership for the Journey to Accountable Care

Examines the progress of an integrated healthcare delivery system in forming an accountable care organization with payer partners as part of the Brookings-Dartmouth ACO Pilot Program, including a focus on performance measurement and reporting

MULTISCALE MODELING OF CARDIAC GROWTH AND BAROREFLEX CONTROL

The heart functions within a complex system that adapts its function to any alteration in loading via several mechanisms. For example, the baroreflex is a short-term feedback loop that modulates the heart\u27s function on a beat-to-beat basis to control arterial pressure. On the other hand, cardiac growth is a long-term adaptive response that occurs over weeks or months in response to changes in left ventricular loading. Understanding the mechanisms that drive ventricular growth and biological remodeling is critical to improving patient care. Multiscale models of the cardiovascular system have emerged as effective tools for investigating G&R, offering the ability to evaluate the effects of molecular-level mechanisms on organ-level function. This dissertation presents MyoFE, a multiscale computer model that simulates the left ventricle (LV) pumping blood around a systemic circulation by bridging from molecular to organ-level mechanisms. The model integrates a baroreflex control of arterial pressure using feedback to regulate heart rate, intracellular Ca2+ dynamics, the molecular-level function of both the thick and thin myofilaments, and vascular tone. MyoFE is extended via a growth algorithm to simulate both concentric growth (wall thickening / thinning) and eccentric growth (chamber dilation / constriction). Specifically, concentric growth is controlled by the time-averaged total stress over the cardiac cycle, while eccentric growth responds to time-averaged intracellular myofiber passive stress. Our integrated model replicated clinical measures of left ventricular growth in two types of valvular diseases - aortic stenosis and mitral regurgitation - at two different levels of severity for each case. Furthermore, our results showed that incorporating the effects of baroreflex control of arterial pressure in simulations of left ventricular growth not only led to more realistic hemodynamics, but also impacted the magnitude of growth. Specifically, our results highlighted the role of regulating venous compliance (vasoconstriction) by the baroreflex immediately after the onset of valvular diseases, which has a significant role on the extent of LV growth in the long term

Examining the potential for information and communication technology to support patients with cardiovascular disease

The overall goal of this work was to investigate the potential of information and communication technology (ICT) to support patients with cardiovascular disease (CVD). There were two specific aims: (1) to determine access to and willingness to use technology for health-related information in patients with CVD; and (2) to develop and pilot test a text-messaging intervention to support patients with acute coronary syndrome (ACS) following discharge from the hospital. The first aim was done with a cross-sectional survey (n=169). ICT ownership was common, as 98% of participants owned at least one ICT device. Computers were the most commonly owned device (88%), the device most commonly used for health information (74% of computer owners), and the device participants had the most interest in using for health information (72% of computer owners). Participants with lower incomes and education levels were less interested in receiving health information on at least one of their devices. The second aim was done with a mixed-methods, assessor-blinded, pilot randomized controlled trial (n=76). An advisory committee composed of patients, researchers, and clinicians developed 48 one-way text messages to send over 60 days to patients with ACS. There were no statistically significant differences between the intervention and usual care groups for self-management domains, medication adherence, health-related quality of life, self-efficacy, and healthcare resource use except for one self-efficacy domain. The study protocol was feasible, except recruitment took longer than anticipated. Ninety-three percent reported they were satisfied with the text messages. In the semi-structured interviews, many participants reported the program made them feel normal, perceived the program to be a source of social support, reinforced they were on the right track, and reminded them of their condition. However, some participants felt they did not need the messages, wished for a more tailored experience, or did not change their behaviours as a result. Learnings from the pilot study should be addressed prior to proceeding to a larger trial. Overall, these two studies indicate that ICT can be acceptable to patients with CVD. Further work needs to be done to determine how to best use ICT to support patients

Examining adherence to activity monitoring devices to improve physical activity in adults with cardiovascular disease: A systematic review

Background Activity monitoring devices are currently being used to facilitate and monitor physical activity. No prior review has examined adherence to the use of activity monitoring devices amongst adults with cardiovascular disease. Methods Literature from June 2012 to October 2017 was evaluated to examine the extent of adherence to any activity monitoring device used to collect objective physical activity data. Randomized control trials comparing usual care against the use of an activity monitoring device, in a community intervention for adults from any cardiovascular diagnostic group, were included. A systematic search of databases and clinical trials registers was conducted using Joanna Briggs Institute methodology. Results Of 10 eligible studies, two studies reported pedometer use and eight accelerometer use. Six studies addressed the primary outcome. Mean adherence was 59.1% (range 39.6% to 85.7%) at last follow-up. Studies lacked equal representation by gender (28.6% female) and age (range 42 to 82 years). Conclusion This review indicates that current research on activity monitoring devices may be overstated due to the variability in adherence. Results showed that physical activity tracking in women and in young adults have been understudied

Visions of Cardiomyocyte

In the field of cardiology, some of the most dramatic advances in recent years have come from understanding the molecular and cellular basis of cardiovascular disease. Knowledge of the pathological basis of disease in some cases allows the development of new strategies for prevention and treatment. This book was planned not only to convey new facts on cardiovascular diseases, but also to boost the excitement and challenges of research in the dynamic area of modern molecular and cellular biology of cardiology. The integration of multilevel biological data and the connection with clinical practice reveal the potential of personalized medicine, with future implications for prognosis, diagnosis, and management of cardiovascular diseases

A socially assistive robot for long-term cardiac rehabilitation in the real world

What are the benefits of using a socially assistive robot for long-term cardiac rehabilitation? To answer this question we designed and conducted a real-world long-term study, in collaboration with medical specialists, at the Fundacion Cardioinfantil-Instituto de Cardiologia clinic (Bogota, Colombia) lasting 2.5 years. The study took place within the context of the outpatient phase of patients' cardiac rehabilitation programme and aimed to compare the patients' progress and adherence in the conventional cardiac rehabilitation programme (control condition) against rehabilitation supported by a fully autonomous socially assistive robot which continuously monitored the patients during exercise to provide immediate feedback and motivation based on sensory measures (robot condition). The explicit aim of the social robot is to improve patient motivation and increase adherence to the programme to ensure a complete recovery. We recruited 15 patients per condition. The cardiac rehabilitation programme was designed to last 36 sessions (18 weeks) per patient. The findings suggest that robot increases adherence (by 13.3%) and leads to faster completion of the programme. In addition, the patients assisted by the robot had more rapid improvement in their recovery heart rate, better physical activity performance and a higher improvement in cardiovascular functioning, which indicate a successful cardiac rehabilitation programme performance. Moreover, the medical staff and the patients acknowledged that the robot improved the patient motivation and adherence to the programme, supporting its potential in addressing the major challenges in rehabilitation programmes

Avoiding 30-day Readmissions of Acute MI Patients Utilizing Cardiac Rehabilitation

A significant number of Acute Myocardial Infarction (AMI) patients were readmitted to an urban San Francisco Medical Center within 5-7 days post discharge this year. Two of the main identified causes were symptom management issues and medication instructions, both of which are part of the discharge instructions. It’s not surprising that 80% of all discharge teaching is forgotten by patients by the time they hit the parking lot. With the recommended timeframe for post discharge follow up appointments at 48 to 72 hours post discharge and as those appointments are not typically available within the recommended timeframe, patients are more likely to be readmitted unless an alternative for post discharge follow up can be created. The intent of this project is to propose the implementation of a hospital based Cardiac Rehabilitation (CR) program that allows AMI patients to participate as early as 48 -72 hours post discharge. This first part, or intake to the CR program would reinforce discharge teaching inclusive of medication reconciliation, symptom management, and all other components taught at discharge. The evidence to be duplicated is that enrollment in a certified cardiac rehab program as early as 48 hours post discharge can prevent readmissions by enhancing the patient/family’s retention and understanding of discharge instructions that include symptom management and medicatio