Remote ECG Monitoring by ECG247 Smart Heart Sensor

Background. Heart rhythm disorders are common and may be associated with serious complications. The quality of the ECG signal is crucial to detect and classify arrhythmias. Most available devices for assessment arrhythmias do not allow for remote monitoring. The Norwegian ECG247 Smart Heart Sensor is a new remote patch monitor developed to simplify the assessment of arrhythmias. This study was aimed at evaluating the quality of the ECG signal from the ECG247 Smart Heart Sensor compared to standard 12-lead ECG. Methods. ECG recordings with ECG247 Smart Heart Sensor and a standard 12-lead ECG recorder were performed in 97 volunteers at Sorlandet Hospital, Arendal, Norway, in 2019. All ECGs were analysed by two independent cardiologists. Results. A total of 97 participants (53% men, age 48 (±14) years) were included in the study. The ability for both systems to use recorded ECG data for arrhythmia detection was good (100%). The quality of the P-wave (mean score 1.1 vs. 1.5) and the QRS complex (mean score 1.0 vs. 1.0) from the ECG247 Smart Heart Sensor and that from the 12-lead ECG were comparable (scale: 1: extremely good, 9: not accepted). Noise artefacts were a minor issue in all recordings. Conclusions. The ECG quality from the ECG247 Smart Heart Sensor was comparable to the ECG quality from the standard 12-lead ECG. The ECG247 Smart Heart Sensor may enable easy and remote diagnostics of heart rhythm disorders. This trial is registered with NCT04700865.publishedVersio

Heart rhythm assessment in elite endurance athletes: A better method?

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Warfarin Guide: Co-design of a Mobile Computer-Assisted Anticoagulant Therapy

Patients with some types of cardiovascular disease are prescribed anticoagulation therapy with Warfarin in order to control the ability of blood clotting. This work presents a co-designed mobile application, called Warfarin Guide, for a computer-assisted anticoagulant therapy. The application addresses the challenges that unexperienced patients may find when having to remember to regularly check their INR values and make temporary adjustments for INR value fluctuations that are not easy to interpret without direct medical advice.publishedVersionnivå

Fully digital self-screening for atrial fibrillation with patch electrocardiogram

Atrial fibrillation (AF) is the most common arrhythmia worldwide. The AF is associated with severe mortality, morbidity, and healthcare costs, and guidelines recommend screening people at risk. However, screening methods and organization still need to be clarified. The current study aimed to assess the feasibility of a fully digital self-screening procedure and to assess the prevalence of undetected AF using a continuous patch electrocardiogram (ECG) monitoring system. Individuals ≥65 years old with at least one additional risk factor for stroke from the general population of Norway were invited to a fully digital continuous self-screening for AF using a patch ECG device (ECG247 Smart Heart Sensor). Participants self-reported clinical characteristics and usability online, and all participants received digital feedback of their results. A total of 2118 individuals with a mean CHA2DS2-VASc risk score of 2.6 (0.9) were enrolled in the study [74% women; mean age 70.1 years (4.2)]. Of these, 1849 (87.3%) participants completed the ECG self-screening test, while 215 (10.2%) did not try to start the test and 54 (2.5%) failed to start the test. The system usability score was 84.5. The mean ECG monitoring time was 153 h (87). Atrial fibrillation was detected in 41 (2.2%) individuals.publishedVersio

User Evaluation of a Smartphone Application for Anticoagulation Therapy

Anticoagulation therapy with Warfarin is used for specific cardiovascular diseases to control the ability of blood clotting. Traditional ways of selfmanagement therapy are based on paper forms and procedures. This paper presents an evaluation of the smartphone application Warfarin Guide, a computer-assisted decision-support system used to help patients in their management of anticoagulation therapy related to International Normalized Ratio (INR) values. The evaluation consisted of a usability test with 4 participants and a field test with 14 participants who used the application at home during four months. A mixed methods research approach included quantitative and qualitative analysis of the test results. The results showed that participants evaluated the Warfarin Guide as ‘useful’ for self-management of anticoagulation therapy, reporting key issues for further improvement.publishedVersionNivå

2020 Update of the quality indicators for acute myocardial infarction : a position paper of the Association for Acute Cardiovascular Care : the study group for quality indicators from the ACVC and the NSTE-ACS guideline group

Aims Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence. Methods and results The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores). Conclusion Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care

Remote ECG Monitoring by ECG247 Smart Heart Sensor

Background. Heart rhythm disorders are common and may be associated with serious complications. The quality of the ECG signal is crucial to detect and classify arrhythmias. Most available devices for assessment arrhythmias do not allow for remote monitoring. The Norwegian ECG247 Smart Heart Sensor is a new remote patch monitor developed to simplify the assessment of arrhythmias. This study was aimed at evaluating the quality of the ECG signal from the ECG247 Smart Heart Sensor compared to standard 12-lead ECG. Methods. ECG recordings with ECG247 Smart Heart Sensor and a standard 12-lead ECG recorder were performed in 97 volunteers at Sorlandet Hospital, Arendal, Norway, in 2019. All ECGs were analysed by two independent cardiologists. Results. A total of 97 participants (53% men, age 48 (±14) years) were included in the study. The ability for both systems to use recorded ECG data for arrhythmia detection was good (100%). The quality of the P-wave (mean score 1.1 vs. 1.5) and the QRS complex (mean score 1.0 vs. 1.0) from the ECG247 Smart Heart Sensor and that from the 12-lead ECG were comparable (scale: 1: extremely good, 9: not accepted). Noise artefacts were a minor issue in all recordings. Conclusions. The ECG quality from the ECG247 Smart Heart Sensor was comparable to the ECG quality from the standard 12-lead ECG. The ECG247 Smart Heart Sensor may enable easy and remote diagnostics of heart rhythm disorders. This trial is registered with NCT04700865

Sex differences in secondary preventive follow-up after coronary heart events

Abstract Background and aims Some studies point to sex differences in cardiovascular preventive practices. The aim of this study was to investigate differences in achievement of secondary preventive targets and long-term outcome in men and women after a coronary heart event. Methods This study was a subanalysis from a randomized controlled trial of hospital-based versus primary care-based secondary preventive follow-up at Sorlandet Hospital, Norway, 2007–2022 and included both groups. The main outcome was achievement of treatment targets two years after the index event. Event-free survival was calculated based on the composite of mortality, coronary intervention, stroke, or myocardial infarction during follow-up. Participants were followed-up for up to 10 years after the index event through out-patient consultations. Results In total, 337 women and 1203 men were eligible for the study. Due to loss of follow-up during the first two years after the index coronary event 106 (7%) participants were excluded from further analysis (53% withdrawal of consent, 12% death, and 35% other causes) leaving 307 (21%) women and 1127 (79%) men. After two years of follow-up we found no differences between women and men in achievement of blood pressure targets (61% vs. 59%; p = 0.57), LDL-cholesterol goals (64% vs. 69%; p = 0.15), HbA1c-goal in patients with diabetes (49% vs. 45%; p = 0.57), non-smoking (79% vs. 81%; p = 0.34), healthy diets (14% vs. 13%, p = 0.89), physical activity (55% vs. 58%; p = 0.38), use of acetylsalicylic acid (93% vs. 94%; p = 0.39), and use of lipid lowering therapy (92% vs. 94%; p = 0.15). After a median follow-up time of 5.0 [SD 3.2] years there were no differences between women and men regarding composite endpoint (89 [30.0%] vs. 345 [30.6]; p = 0.58), and composite endpoint-free survival did not differ between women and men (hospital-based follow-up HR for women versus men, 0.87, 95% CI 0.62–1.23; p = 0.44 and primary care service HR for women versus men 0.95, 95% CI 0.69–1.31; p = 0.78). Conclusions The study show no sex differences in achievement of secondary preventive targets or composite endpoint after coronary heart events. However, many women and men did not achieve treatment goals, and further improvement in secondary prevention is needed. Trial registration The study is registered in ClinicalTrials.gov (NCT00679237)

Association of Troponin T measurements with long-term outcomes in patients with coronary artery disease participating in a secondary prevention trial

Abstract Background and aims Identification of high-risk patients in secondary cardiovascular prevention may be challenging, although risk stratification tools are available. Cardiac troponins might have predictive value in identification of high-risk patients. The aim of this study was to investigate the association between cardiac Troponin T (cTnT) levels following a coronary event and long-term outcomes. Methods This study was carried out as a subanalysis from a randomized controlled trial conducted at Sørlandet Hospital, Norway, where patients hospitalized with myocardial infarction (MI) or scheduled percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) were included between 2007 and 2017. Participants were followed-up for up to 10 years after the index event through out-patient consultations. cTnT was assessed at each consultation as well as information regarding new cardiovascular events or death. Results A total of 1278 patients (18–80 years) with complete measurements of cTnT were included. cTnT was elevated (≥ 14 ng/L) one year after the primary event in 241 (19%) of participants. Median follow-up was 5.7 [SD 2.7] years. Cox regression analyses showed reduced survival (adjusted HR 0.37, 95% CI 0.19–0.72; p = 0.003) and composite endpoint-free survival (adjusted HR 0.73, 95% CI 0.55–0.98; p = 0.04) in participants with elevated cTnT versus participants with low cTnT after adjustment for risk factors at inclusion and randomization assignment. Conclusions Assessment of cTnT after coronary heart events may help identify patients at high risk of poor outcomes and might contribute to more focused secondary preventive treatment. Trial registration The study is registered in ClinicalTrials.gov (NCT00679237)

Endringsvillighet og endringskapasitet i sykehus under covid-19 pandemi - endringsledelse i krisetid ved Sørlandet sykehus Arendal

Master's thesis in Management (ORG917