Examining the Base Rates of Atrial Fibrillation in Eastern North Carolina: Community Screening, Associated Risk Factors, and Psychological Correlates of Disease

Background: Eastern North Carolina has historically high prevalence rates of cardiovascular disease. Novel solutions such as mobile screening technology may aid in reaching this region’s vulnerable health population to prevent further disease progression. Additionally, symptoms of psychological distress are commonly comorbid with cardiovascular disease but often overlooked as formal predictors or modifiers of increased disease burden. Behavioral medicine providers recognize the importance of screening for psychological stress as it relates to cardiovascular disease as a way to reduce disease burden and advancement. Therefore, mobile-ECG screening for atrial fibrillation and exploration of adding psychological variables to a well-established cardiovascular stroke risk calculator (CHA₂DS₂-VASc) are discussed. Methods: Participants (N = 250) were approached at pharmacies in Eastern North Carolina. Participants completed demographic and medical history questionnaires, the DASS-21, and were administered a single-lead mobile-ECG (mECG). All mECG readings were interpreted by the mECG device in addition to adjudication by three electrophysiologists. Medical referrals were provided when indicated. Chi-squared statistics were utilized to investigate regional rates of atrial fibrillation and associated risk factors. Binary logistic regression modeling measured the capability of the CHA₂DS₂-VASc stroke risk calculator to predict abnormal mECG readings both with and without the addition of DASS-21 symptom scores. Results: Rates of previously undiagnosed atrial fibrillation were much higher than rates found in studies of similar scope and design. Participants’ average CHA₂DS₂-VASc scores (2.68 ± 1.35) signify an alarming rate of untreated ischemic stroke risk in a community sample. Additionally, the prevalence rates of six, known independent stroke risk factors were also significantly higher in the study sample than reported national US averages. Significant correlations were not found between psychological endpoints and abnormal mECG readings or elevated CHA₂DS₂-VASc scores, but binary logistic regression modeling revealed that a longstanding stroke risk calculator could be potentially strengthened with the addition of one (anxiety) or three (depression, anxiety, and stress) psychological endpoints. Discussion: The results of the current study further the knowledge of the utility of using mobile-health techniques to capture previously undiagnosed atrial fibrillation and associated risk factors. Prevalence of chronic disease and other health metrics in the Eastern North Carolina region are substantially worse than the general US population. Additionally, the results presented begin a compelling argument for the addition of psychological symptom scores to a long-standing stroke risk calculator

Cardiac Monitoring with Smartphones: MobileECG Usage in ICD Patients

Background: Addressing behavioral risk factors and having access to high quality medical care with increased information, biometrics, and treatment planning could reduce global cardiovascular mortality. There has been a surge of medical technologies that can help prevent, manage, and even forecast medically distressing cardiovascular events. As a new wave of medical technologies are developed, patients will increasingly be considered “key personnel� in the process of using novel techniques to improve self-care, engagement and overall quality of life. The purpose of this study was to examine the perceived added value of smartphone-ECG technology to an ICD patient user experience. Methods: Fifty-one participants were recruited from an existing ICD patient population at the East Carolina Heart Institute in Greenville, North Carolina. Participants were given smartphone-ECG devices and asked to take a thirty-second reading at least once per day. In addition to overall technology satisfaction, three major constructs were examined in this population including cardiac and device-specific anxiety, quality of life, and self-management. Time points of data collection were at baseline, thirty-day, and ninety-day. Results: The current study findings indicate that smartphone-ECG technology is widely accepted and positively appraised by this user base. Positive technology appraisal did not correlate to significant within-group changes in domains of quality of life and self-management after using the technology for thirty days. ICD shock anxiety was significantly increased during the period of technology usage, which may have been maintained by the task of using a device that required them to focus on their disease state at least once per day. Conversely, overall ICD device acceptance increased significantly indicating that the external technology use of the mECG device may have led to positive appraisals of their implantable devices. Discussion: The results of the current study further the knowledge of the mobile-health field by asking a series of simple, yet important, questions related to device acceptance and technology satisfaction. Medical technology development will most likely continue to outpace the speed at which clinicians and researchers are able to critically evaluate and integrate novel technology into their patient care centers. QoL, shock-related anxiety, and more general cardiac anxiety remain important treatment targets among ICD patient populations

Cardiac Monitoring with Smartphones: MobileECG Usage in ICD Patients

"Background: Addressing behavioral risk factors and having access to high quality medical care with increased information , biometrics , and treatment planning could reduce global cardiovascular mortality. There has been a surge of medical technologies that can help prevent , manage , and even forecast medically distressing cardiovascular events. As a new wave of medical technologies are developed , patients will increasingly be considered ""key personnel€ in the process of using novel techniques to improve self-care , engagement and overall quality of life. The purpose of this study was to examine the perceived added value of smartphone-ECG technology to an ICD patient user experience. Methods: Fifty-one participants were recruited from an existing ICD patient population at the East Carolina Heart Institute in Greenville , North Carolina. Participants were given smartphone-ECG devices and asked to take a thirty-second reading at least once per day. In addition to overall technology satisfaction , three major constructs were examined in this population including cardiac and device-specific anxiety , quality of life , and self-management. Time points of data collection were at baseline , thirty-day , and ninety-day. Results: The current study findings indicate that smartphone-ECG technology is widely accepted and positively appraised by this user base. Positive technology appraisal did not correlate to significant within-group changes in domains of quality of life and self-management after using the technology for thirty days. ICD shock anxiety was significantly increased during the period of technology usage , which may have been maintained by the task of using a device that required them to focus on their disease state at least once per day. Conversely , overall ICD device acceptance increased significantly indicating that the external technology use of the mECG device may have led to positive appraisals of their implantable devices. Discussion: The results of the current study further the knowledge of the mobile-health field by asking a series of simple , yet important , questions related to device acceptance and technology satisfaction. Medical technology development will most likely continue to outpace the speed at which clinicians and researchers are able to critically evaluate and integrate novel technology into their patient care centers. QoL , shock-related anxiety , and more general cardiac anxiety remain important treatment targets among ICD patient populations.

Examining the Base Rates of Atrial Fibrillation in Eastern North Carolina: Community Screening , Associated Risk Factors , and Psychological Correlates of Disease

Background: Eastern North Carolina has historically high prevalence rates of cardiovascular disease. Novel solutions such as mobile screening technology may aid in reaching this region's vulnerable health population to prevent further disease progression. Additionally , symptoms of psychological distress are commonly comorbid with cardiovascular disease but often overlooked as formal predictors or modifiers of increased disease burden. Behavioral medicine providers recognize the importance of screening for psychological stress as it relates to cardiovascular disease as a way to reduce disease burden and advancement. Therefore , mobile-ECG screening for atrial fibrillation and exploration of adding psychological variables to a well-established cardiovascular stroke risk calculator (CHA‚‚DS‚‚-VASc) are discussed. Methods: Participants (N = 250) were approached at pharmacies in Eastern North Carolina. Participants completed demographic and medical history questionnaires , the DASS-21 , and were administered a single-lead mobile-ECG (mECG). All mECG readings were interpreted by the mECG device in addition to adjudication by three electrophysiologists. Medical referrals were provided when indicated. Chi-squared statistics were utilized to investigate regional rates of atrial fibrillation and associated risk factors. Binary logistic regression modeling measured the capability of the CHA‚‚DS‚‚-VASc stroke risk calculator to predict abnormal mECG readings both with and without the addition of DASS-21 symptom scores. Results: Rates of previously undiagnosed atrial fibrillation were much higher than rates found in studies of similar scope and design. Participants' average CHA‚‚DS‚‚-VASc scores (2.68 ± 1.35) signify an alarming rate of untreated ischemic stroke risk in a community sample. Additionally , the prevalence rates of six , known independent stroke risk factors were also significantly higher in the study sample than reported national US averages. Significant correlations were not found between psychological endpoints and abnormal mECG readings or elevated CHA‚‚DS‚‚-VASc scores , but binary logistic regression modeling revealed that a longstanding stroke risk calculator could be potentially strengthened with the addition of one (anxiety) or three (depression , anxiety , and stress) psychological endpoints. Discussion: The results of the current study further the knowledge of the utility of using mobile-health techniques to capture previously undiagnosed atrial fibrillation and associated risk factors. Prevalence of chronic disease and other health metrics in the Eastern North Carolina region are substantially worse than the general US population. Additionally , the results presented begin a compelling argument for the addition of psychological symptom scores to a long-standing stroke risk calculator

Examining the Base Rates of Atrial Fibrillation in Eastern North Carolina: Community Screening, Associated Risk Factors, and Psychological Correlates of Disease

Background: Eastern North Carolina has historically high prevalence rates of cardiovascular disease. Novel solutions such as mobile screening technology may aid in reaching this region’s vulnerable health population to prevent further disease progression. Additionally, symptoms of psychological distress are commonly comorbid with cardiovascular disease but often overlooked as formal predictors or modifiers of increased disease burden. Behavioral medicine providers recognize the importance of screening for psychological stress as it relates to cardiovascular disease as a way to reduce disease burden and advancement. Therefore, mobile-ECG screening for atrial fibrillation and exploration of adding psychological variables to a well-established cardiovascular stroke risk calculator (CHA2DS2-VASc) are discussed.\r\n\r\nMethods: Participants (N = 250) were approached at pharmacies in Eastern North Carolina. Participants completed demographic and medical history questionnaires, the DASS-21, and were administered a single-lead mobile-ECG (mECG). All mECG readings were interpreted by the mECG device in addition to adjudication by three electrophysiologists. Medical referrals were provided when indicated. Chi-squared statistics were utilized to investigate regional rates of atrial fibrillation and associated risk factors. Binary logistic regression modeling measured the capability of the CHA2DS2-VASc stroke risk calculator to predict abnormal mECG readings both with and without the addition of DASS-21 symptom scores.\r\n\r\nResults: Rates of previously undiagnosed atrial fibrillation were much higher than rates found in studies of similar scope and design. Participants’ average CHA2DS2-VASc scores (2.68 ± 1.35) signify an alarming rate of untreated ischemic stroke risk in a community sample. Additionally, the prevalence rates of six, known independent stroke risk factors were also significantly higher in the study sample than reported national US averages. Significant correlations were not found between psychological endpoints and abnormal mECG readings or elevated CHA2DS2-VASc scores, but binary logistic regression modeling revealed that a longstanding stroke risk calculator could be potentially strengthened with the addition of one (anxiety) or three (depression, anxiety, and stress) psychological endpoints.\r\n\r\nDiscussion: The results of the current study further the knowledge of the utility of using mobile-health techniques to capture previously undiagnosed atrial fibrillation and associated risk factors. Prevalence of chronic disease and other health metrics in the Eastern North Carolina region are substantially worse than the general US population. Additionally, the results presented begin a compelling argument for the addition of psychological symptom scores to a long-standing stroke risk calculator