Cardiac Health Status Research Articles

Heart Diseases Recognition Model Based on HRV Feature Extraction over 12-Lead ECG Signals.

Heart Rate Variability (HRV) refers to the capability of the heart rhythm to vary at different times, typically reflecting the regulation of the heart by the autonomic nervous system. In recent years, with advancements in Electrocardiogram (ECG) signal processing technology, HRV features reflect various aspects of cardiac activity, such as variability in heart rate, cardiac health status, and responses. We extracted key features of HRV and used them to develop and evaluate an automatic recognition model for cardiac diseases. Consequently, we proposed the HRV Heart Disease Recognition (HHDR) method, employing the Spectral Magnitude Quantification (SMQ) technique for feature extraction. Firstly, the HRV signals are extracted through electrocardiogram signal processing. Then, by analyzing parts of the HRV signal within various frequency ranges, the SMQ method extracts rich features of partial information. Finally, the Random Forest (RF) classification computational method is employed to classify the extracted information, achieving efficient and accurate cardiac disease recognition. Experimental results indicate that this method surpasses current technologies in recognizing cardiac diseases, with an average accuracy rate of 95.1% for normal/diseased classification, and an average accuracy of 84.8% in classifying five different disease categories. Thus, the proposed HHDR method effectively utilizes the local information of HRV signals for efficient and accurate cardiac disease recognition, providing strong support for cardiac disease research in the medical field.

Shared Medical Appointments in Heart Failure for Post Acute Care Follow-Up: A Randomized Controlled Trial.

Shared medical appointments (SMAs) in heart failure (HF) are medical visits where several patients with HF meet with multidisciplinary providers at the same time for efficient and comprehensive care. It is unknown whether HF-SMAs can improve overall and cardiac health status for high-risk patients with HF discharged from acute care. A 3-site, open-label, randomized-controlled-trial was conducted. Participants within 12 weeks of HF acute care (emergency-room/hospitalization) requiring intravenous diuretic therapy were randomized to receive either HF-SMA or usual HF clinical care (usual-care) on a 1:1 ratio. The HF-SMA team, which consisted of a nurse, nutritionist, psychologist, nurse practitioner and/or a clinical pharmacist, provided four 2-hour session HF-SMAs that met every other week for 8 weeks. Primary outcomes were the overall health status measured by European Quality of Life Visual Analog Scale and cardiac health status by Kansas City Cardiomyopathy Questionnaire, 180 days postrandomization. Of the 242 patients enrolled (HF-SMA n=117, usual-care n=125, mean age 69.3±9.4 years, 71.5% White patients, 94.6% male), 84% of participants completed the study (n=8 HF-SMA and n=9 usual-care patients died). After 180 days, both HF-SMA and usual-care participants had significant improvements from baseline in Kansas City Cardiomyopathy Questionnaire that were not statistically different. Only HF-SMA participants had significant improvements in European Quality of Life Visual Analog Scale (mean change = 7.2±15.8 in HF-SMA versus -0.4±19.0 points in usual-care, P < 0.001). Both HF-SMA and usual-care in participants with HF achieved significant improvements in cardiac health status, but only a team approach through HF-SMA achieved significant improvements in overall health status. Future larger studies are needed to evaluate hospitalization and death outcomes. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02481921.

Assisting Black Patients With Decision-Making for Implantable Cardioverter Defibrillator Therapy: Qualitative Findings From the Videos to Reduce Racial Disparities in ICD Therapy via Innovative Designs (VIVID) Trial.

The VIVID (Videos for Addressing Racial Disparities in Implantable Cardioverter Defibrillator Therapy via Innovative Designs) study was a multicenter, randomized controlled trial aimed at evaluating the effectiveness of a video-based decision support tool in enhancing informed consent for implantable cardioverter defibrillator (ICD) implantation among Black patients who met guideline criteria for primary prevention ICDs. Within the broader VIVID randomized trial, a qualitative investigation was conducted to elucidate the decisional factors among Black individuals considering ICD implantation for the primary prevention of sudden cardiac arrest. Between October 2016 and July 2019, in-depth interviews were conducted at 2 time points from randomization, ≈7 days (time interval for the decision) and at 90 days; the time interval for determining ICD implantation. Interview findings were categorized by randomized groups, those assigned to 1 of the 2 encounter-based video decision support tools or standard care (without video). Interview participants were purposefully selected to ensure diversity across gender, age, educational background, research site, and randomization group; participants were sampled from 14 academic and community-based electrophysiology clinics in the United States. Data analysis employed applied thematic analysis techniques. A diverse sample of Black individuals were interviewed at 1 week (n=59; female, 37.3%) and 90 days (n=48; female, 39.6%). The primary factors influencing the decisions of Black individuals considering a primary prevention ICD implantation were (1) their clinicians' recommendations for ICD implantation; (2) their perception of their cardiac health status; and (3) a desire to prolong their lives for the sake of their families. These findings offer valuable insights that may guide clinicians in their communication with Black patients during shared decision-making encounters related to ICD implantation.

Impact of cardiac health status on bone marrow cell secretome and myocardial repair

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): University of Fribourg Graduate assistant Background Restoring the damaged myocardium remains a significant clinical challenge. Administration of bioactive factors, exosomes, or cell secretomes has shown promising results in promoting angiogenesis, tissue repair, immunomodulation, and extracellular matrix remodelling, particularly for cardiovascular disease treatments. Bone marrow (BM) cells are an essential source of secretome-based therapies for myocardial infarction (MI). Harnessing the potential of the cellular secretome for therapeutic applications requires a comprehensive understanding of its composition, functions, and mechanisms of action. MI affects the entire hematopoietic hierarchy, from stem cells to myeloid progenitors in BM. The study investigates how the cardiac status healthy versus infarcted affects the BM cell compositions and the properties of their secretomes. Methods Bone marrow cells (BMC) were isolated from healthy male Lewis rats (hBMC) and infarcted one (iBMC) obtained 2 weeks post MI induced by coronary artery ligation and cultured for 2 weeks. Cells composition, particularly macrophages, was characterised using multiplex flow cytometry Cytek Aurora. (CD90, CD29, CD45. CD68, CD206, CD163, Arg1, CD80, CCR7, iNOS). Cell proliferation (Real-time cell analyser and EdU incorporation), metabolic assays (seahorse assays), PCR, MS proteomic, and potency assays for immunomodulatory properties were performed. Results Multiplex flow cytometry showed distinctions in the percentage of cells: CD34+ stem cells and hematopoietic CD45+ cells were significantly upregulated in hBMCs, while CD68+ cells were higher in iBMCs. Cell proliferation assay demonstrated that iBMCs had significantly lower proliferation rates compared to hBMCs. Cell Metabolism was also impacted, iBMCs showed increased basal respiration, ATP production, and maximal respiration compared to hBMCs. An increase in respiratory spare capacity in iBMCs suggests an increased potential for ATP production under increased energy demands. Relative to hBMC, iBMC significantly regulated the expression of genes involved in immune response, inflammation, angiogenesis, and ECM remodelling gm-csf, il-17, vcam1, stat6, mmp9, cam, arg1, mhcII, arg2 were downregulated and tlr2, cxcl10, il-6, timp1, rantes, mcp-1, vegf, il-1ra, il-1beta, mip-1alpha, tlr4, b2m, and mmp3 upregulated. Secreted proteins also varied. Finally, the secretome of iBMC showed an enhanced capacity to induce a phenotype switch of macrophages toward an anti-inflammatory profile. Conclusion Our study shows that MI significantly alters the properties of bone marrow cells, impacting their composition, proliferation, metabolism, gene expression and the immunomodulatory potential of the secretome. These findings highlight the importance of considering donor health status in developing restoring secretome-based therapies for cardiac repair and emphasise the need to incorporate potency assay of the biologics for a standardised therapy and quality control.

Feasibility and validity of using deep learning to reconstruct 12-lead ECG from three‑lead signals

BackgroundIn the field of mobile health, portable dynamic electrocardiogram (ECG) monitoring devices often have a limited number of lead electrodes due to considerations, such as portability and battery life. This situation leads to a contradiction between the demand for standard 12‑lead ECG information and the limited number of leads collected by portable devices. MethodsThis study introduces a composite ECG vector reconstruction network architecture based on convolutional neural network (CNN) combined with recurrent neural network by using leads I, II, and V2. This network is designed to reconstruct three‑lead ECG signals into 12‑lead ECG signals. A 1D CNN abstracts and extracts features from the spatial domain of the ECG signals, and a bidirectional long short-term memory network analyzes the temporal trends in the signals. Then, the ECG signals are inputted into the model in a multilead, single-channel manner. ResultsUnder inter-patient conditions, the mean reconstructed Root mean squared error (RMSE) for precordial leads V1, V3, V4, V5, and V6 were 28.7, 17.3, 24.2, 36.5, and 25.5 μV, respectively. The mean overall RMSE and reconstructed Correlation coefficient (CC) were 26.44 μV and 0.9562, respectively. ConclusionThis paper presents a solution and innovative approach for recovering 12‑lead ECG information when only three‑lead information is available. After supplementing with comprehensive leads, we can analyze the cardiac health status more comprehensively across 12 dimensions.

Artificial intelligence-assisted examination of cardiac health status through electrocardiogram

Abstract Background Cardiac diseases are the main causes of death. Echocardiogram is the standard testing tool of heart diseases but it is inconvenient and expensive. This study aims at developing an artificial intelligence (AI)-assisted method to interpret electrocardiograms (ECG) for cardiac health status. Method A total of 70757 subjects undergoing concomitant ECG and echocardiography were enrolled. ECG was analyzed by using Philips DXL algorithm to obtain 512 parameters, and a healthy heart is defined by normal cardiac chamber size, myocardial thickness, systolic function, diastolic function, and valvular function. A multi-layer perceptron (MLP) and Long short term memory (LSTM) were developed with hold-out validation (training dataset 80% and testing dataset 20%). Three categories of input data are made based on the percentage of healthy data of 30.6%. Death of the participants were confirmed via linking database to the National Death Registry A Kaplan-Meier survival curve analysis was conducted in the testing dataset stratified by AI-determined cardiac health status. Results The testing results of the proposed methods on an independent dataset are shown in Table 1. It is interesting that using MLP has similar performance as the LSTM model. Furthermore, the 30-layer MLP model has a F1 value of 83.8% and the 50-layer MLP model has a F1 value of 83.8, while the F1 value of 2-layer LSTM_0.2 is 85.2% and 2-layer LSTM_0.2 is 84.6%. In addition, AI-determined healthy hearts were associated with better long-term survival. Conclusion An AI-assisted analysis on ECG can act as a preliminary examination of cardiac diseases to facilitate the arrangement of echocardiograms for early detections.

Design of a System for the Protection of Cardiac Data

The recording, processing, analysis and storage of cardiac data is an essential step in achieving better care for the cardiac health status of patients. An important aspect in the processing and access to this type of data is the ability to reliably protect it from unauthorized access. The article shows an automated system for registration and mathematical analysis of cardiac data and methods for their protection. Information protection is achieved by implementing two-factor authentication. The characteristic of two-factor authentication is that access to the system takes place in two stages: entering a password as the first step and a code/key as the second. In this way, for protection, unauthorized access to the patient 39 file, including personal information and results of cardiac tests, is prevented.

Abstract P175: Shared Medical Appointments in Heart Failure for Post-Hospitalization Follow-Up

Introduction: Shared medical appointments (SMAs) are medical visits where several patients with a common disease have clinic at the same time with medical provider(s). SMAs in heart failure (HF) is a unique opportunity where providers of different disciplines, one of which is a prescriber with HF expertise, can improve the health of patients recently discharged with HF. Hypothesis: Compared with usual care, patients discharged with HF randomized to a HF-SMA will experience better cardiac health status as measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) and overall health status as measured by the EQ-5D Visual Analog Scale (EQ5D-VAS) Methods: We conducted a 3-site open label randomized-controlled trial of parallel design. Participants within 12 weeks of a HF hospitalization were randomized to receive either HF-SMA versus usual care. The HF-SMA team consisted of a nurse, nutritionist, psychologist, nurse practitioner and/or a clinical pharmacist and included four 2 hour sessions that met every other week for 8 weeks. Primary outcomes are overall health status measured by EQ5D-VAS (range 0-100 with 0 = worst health and 100 = Best health) and cardiac health status by KCCQ (range 0-100, higher score is better cardiac health), after 180 days post randomization. Results: Of the 242 patients enrolled (mean age 69.3±9.4 years, 71.5% white, 94.6% male), 83.8% HF-SMA and 84.8% usual care participants completed the study. Although both groups had significant improvements from baseline in their overall health status, patients in the HF-SMA intervention experienced a greater improvement in EQ5D-VAS scores than usual care (change = 7.2 ± 15.8 versus -0.4 ± 19.0 points, p&lt;0.001, respectively). There were no significant differences between the groups in the cardiac health status KCCQ Summary or Clinical Scores. Conclusion: HF-SMA achieved higher Improvements in overall health status than usual care but not in cardiac health status. Future studies should power to compare data on event outcomes to better understand impact.

Cardiac disease in pregnancy and the first year postpartum: a story of mental health, identity and connection

BackgroundWomen with cardiac disease in pregnancy and the first year postpartum often face uncertainty about their condition and the trajectory of their recovery. Cardiac disease is a leading cause of serious maternal morbidity and mortality, and the prevalence is increasing. Affected women are at risk of worsening cardiac disease, chronic illness, mental illness and trauma. This compounded risk may lead to significant and long-term negative outcomes. The aim of this study is to correct the lack of visibility and information on the experiences of women with cardiac disease in pregnancy and the first year postpartum.MethodsA qualitative study using in-depth semi-structured interviews with twenty-five women who had acquired, congenital or genetic cardiac disease during pregnancy or the first year postpartum. Data were analysed and interpreted using a thematic analysis framework.ResultsAnalysis of the interviews produced three major themes: 1) Ground zero: index events and their emotional and psychological impact, 2) Self-perception, identity and worthiness, and 3) On the road alone; isolation and connection. There was a narrative consistency across the interviews despite the women being diverse in age, cardiac diagnosis and cardiac health status, parity and timing of diagnosis. The thread prevailing over the temporal and clinical differences was one of distress, biographical disruption, identity, isolation, a necessitated re-imagining of their lives, and the process of multi-layered healing.ConclusionAcknowledging and understanding the breadth, complexity and depth of women’s experiences is fundamental to improving outcomes. Our findings provide unique insights into women’s experiences and challenges across a spectrum of diseases. Most women did not report an isolated trauma or distressing event, rather there was a layering and persistence of psychological distress necessitating enhanced assessment, management and continuity of care beyond the routine 6-week postpartum check. Further research is required to understand long-term outcomes and to refine the findings for specific disease cohorts to be able to respond effectively.

A novel hybrid deep learning method with cuckoo search algorithm for classification of arrhythmia disease using ECG signals

This work presents an efficient hybridized approach for the classification of electrocardiogram (ECG) samples into crucial arrhythmia classes to detect heartbeat abnormalities. The physiological detection using electrocardiogram (ECG) signals has been the most popular means and widely accepted automated detection system to monitor heart health. Additionally, arrhythmia beat classification plays a prominent role in electrocardiogram (ECG) analysis dedicated elucidate cardiac health status while analyzing heart rhythm. The authors aim to classify ECG samples into major arrhythmia classes precisely by removing the inherent noise of ECG signals in preprocessing phase using discrete wavelet transformation (DWT). The QRS complex plays a crucial role in ECG signal identification. Therefore, the position and amplitude of R-peaks are determined to detect the QRS complex. The feature vectors of the QRS complex are further optimized with cuckoo search (CS) optimization algorithm in addition to denoising signals using DWT to select the most relevant set of features. The Support vector machine (SVM)-trained support vector contains the best training information used to train feed-forward back-propagation neural network (FFBPNN) to propose the variant DWT + CS + SVM-FFBPNN to classify signals among five classes. MIT-BIH arrhythmia database is utilized for different types of heartbeats. The classification analysis based on a variant with optimized feature vector using cuckoo search algorithm and SVM-FFBPNN determines heart rate with an accuracy of 98.319%. In contrast, the variant FFBPNN without optimization obtains 97.95% accuracy. The improved performance of the novel combination of classifiers resulted in overall classification accuracy of 98.53% with precision and recall of 98.247% and 95.68%, respectively. The simulation analysis comprising 3600 samples and 1160 heartbeats also outperformed the existing arrhythmia classifications performed based on neural networks. This illustrates the success of the proposed ECG classification model in accurately categorizing ECG signals for arrhythmia classification.

The indication for fertility preservation in women with Turner syndrome should not only be based on the ovarian reserve but also on the genotype and expected future health status.

Fertility preservation in women with Turner syndrome is highly controversial. Some strongly recommend freezing of ovarian tissue at a young age, others do not. The controversy is partly due to different perspectives and professions. Biologists prefer to freeze young ovaries with high follicle density, reproductive physicians want to avoid risky operations and iatrogenic infertility by removing one ovary, and cardiologists and obstetricians warn against the risks of later pregnancies. Accordingly, fertility preservation in young women with Turner syndrome is more than just the freezing of ovarian tissue or oocytes. Fertility preservation requires a balanced decision considering the conservation of fertility, the protection of reproductive health, and future health consequences. Therefore, fertility preservation strategies should be based not only on the individual ovarian reserve but also on the genotype and the expected cardiac health status to decide what is the best option: to freeze tissue or alternatively to wait and see.

Current Status of Cardiovascular Medicine in Israel.

Current Status of Cardiovascular Medicine in Israel.

Clinician Perspectives on the Design and Application of Wearable Cardiac Technologies for Older Adults: Qualitative Study.

BackgroundNew wearable devices (for example, AliveCor or Zio patch) offer promise in detecting arrhythmia and monitoring cardiac health status, among other clinically useful parameters in older adults. However, the clinical utility and usability from the perspectives of clinicians is largely unexplored.ObjectiveThis study aimed to explore clinician perspectives on the use of wearable cardiac monitoring technology for older adults.MethodsA descriptive qualitative study was conducted using semistructured focus group interviews. Clinicians were recruited through purposive sampling of physicians, nurses, and allied health staff working in 3 tertiary-level hospitals. Verbatim transcripts were analyzed using thematic content analysis to identify themes.ResultsClinicians representing physicians, nurses, and allied health staff working in 3 tertiary-level hospitals completed 4 focus group interviews between May 2019 and July 2019. There were 50 participants (28 men and 22 women), including cardiologists, geriatricians, nurses, and allied health staff. The focus groups generated the following 3 overarching, interrelated themes: (1) the current state of play, understanding the perceived challenges of patient cardiac monitoring in hospitals, (2) priorities in cardiac monitoring, what parameters new technologies should measure, and (3) cardiac monitoring of the future, “the ideal device.”ConclusionsThere remain pitfalls related to the design of wearable cardiac technology for older adults that present clinical challenges. These pitfalls and challenges likely negatively impact the uptake of wearable cardiac monitoring in routine clinical care. Partnering with clinicians and patients in the co-design of new wearable cardiac monitoring technologies is critical to optimize the use of these devices and their uptake in clinical care.

Development of a Wearable Remote Cardiac Health Monitoring with Alerting System

Remote monitoring with alerting systems becomes unavoidable in the field of remote healthcare. The efficiency of such a system depends on accuracy, easy-to-use, versatility, and cost-effectiveness. In this study, a remote cardiac health monitoring along with the alert raising facility is presented. Special design techniques have been adopted to craft the photoplethysmography (PPG) sensor to overcome the congenital limitations like pressure disturbance, the influence of ambient light and motion artifacts. Three key components like pulse rate (PR), blood pressure (BP) and heart rate variability (HRV) are considered to monitor the cardiac health status. A novel algorithm has been developed to detect the cardiac health status of any subject from the above-mentioned physiological parameters. Also, the variation of human skin tone across demography is considered to minimize the impact of skin structure variability in PPG-based cardiac parameter measurement. Decentralized remote monitoring architecture is implemented using the virtual network computing (VNC) platform. We conducted a trial where the training dataset consisted of data from 70 volunteers and the trial dataset considered 20 new volunteers. The overall accuracy of cardiac health monitoring achieved is 98.5%. The experimental results demonstrate the good promise of reliable and efficient system architecture.

Maternal and Early Postnatal Diet Supplemented with Conjugated Linoleic Acid Isomers Affect Lipid Profile in Hearts of Offspring Rats with Mammary Tumors.

Simple SummaryProper feeding during pregnancy and breastfeeding plays an important role in ensuring the health of offspring in childhood as well as in adulthood. The idea of the “developmental origin of health and disease” (DOHaD) assumes that stimuli acting during fetal life cause long-term developmental and physiological changes in the main organs and influence the risk of many diseases. Our research, connected with DOHaD, made an attempt to evaluate the impact of the diet modification of mothers through the addition of conjugated linoleic acid isomers (CLA) on the lipid profile, fatty acid profile and the oxidative stress in the hearts of offspring with breast cancer. Earlier studies utilizing CLA in DOHaD concerned their impact on reducing the incidence of cancer. Considering reports on the co-occurrence of cardiovascular diseases (CVD) in oncological patients as a result of tumor development and also after chemotherapy and radiotherapy, further research is needed to assess the potential protective effect of CLA isomers in CVD. For this purpose, the content of selected CVD biomarkers was determined using modern analytical techniques. Our research has tried to explain the physiological role of CLA and its mechanism of action in the context of maintaining good health and in the prevention of non-communicable diseases.Linking the early life environment with later health status is known as “developmental programming”. This study aimed to assess whether the introduction of conjugated linoleic acids (CLAs) into the maternal diet affects the content fatty acids (FAs), conjugated FAs (CFAs), cholesterol, oxysterols, malondialdehyde (MDA) and tocopherols in the hearts of their female offspring treated with 7,12-dimethylbenz[a]anthracene and if offspring supplementation enhanced the effect of maternal supplementation. FA, cholesterol and oxysterol contents were determined by gas chromatography-mass spectrometry, while contents of CFAs and MDA were determined by high-performance liquid chromatography (HPLC) with photodiode detection. The supplementation of mothers with CLAs significantly decreased the amount of atherogenic saturated FAs and enhanced the level of eicosapentaenoic FA in the hearts of offspring. Continuous progeny supplementation decreased the content of arachidonic acid in hearts. Supplementation of the maternal diet with CLAs and its continuation during the postnatal period increased the ratio of hypo to hypercholesterolemic FAs. Significantly fewer oxysterols were detected in the hearts of progeny of dams fed with CLAs as compared to the offspring of mothers receiving safflower oil. Both fetal and postnatal CLA intake significantly reduced 7β-hydroxycholesterol accumulation. It can be concluded that CLA supplementation during the fetal and postnatal period may be an effective method of maintaining the cardiac health status of newborns.

GREAT APE HEART PROJECT GUIDELINES FOR THE ECHOCARDIOGRAPHIC ASSESSMENT OF GREAT APES.

Cardiovascular disease (CVD) has been identified as a major cause of mortality in all four great ape taxa in zoologic institutions. In an effort to better understand and treat CVD in captive great apes, a program called the Great Ape Heart Project (GAHP), based at Zoo Atlanta, collects and maintains a database of echocardiograms and other relevant medical information relating to the cardiac health status of great apes. Cardiac health assessments have become standard practice among North American zoos that house great apes and are recommended by all four great ape Species Survival Plans (SSP) for the assessment of CVD in captive great apes. As of December 31, 2017, more than 70 ape-holding institutions have submitted approximately 1,100 cardiac examinations of great apes to the GAHP, information from which is stored in the GAHP database. Transthoracic echocardiography is one of the most practical and cost-effective diagnostic imaging techniques for the evaluation of cardiac function in great apes. Standardization of echocardiographic measurements is critical for maximizing the diagnostic value of an echocardiographic exam and for utilization of stored information in comparative studies within and between the great ape taxa. The following manuscript offers suggestions for standardization of nomenclature, imaging technique, echocardiographic measurements, data storage, and reporting of cardiac exams for submission into the GAHP database with the goal of promoting consistency and quality in data collection.

772 Wearable Cardiac Technologies for Older Adults, Clinician Perspectives on the Design and Application

New devices offer promise in the detection of arrhythmia and monitoring cardiac health status amongst other clinically useful parameters. However, the clinical utility and usability from the perspectives of clinicians is largely unexplored. This study aimed to explore clinician perspectives on the use of wearable cardiac monitoring technology for older adults. Descriptive qualitative study using semi-structured focus group interviews. Clinicians were recruited through purposive sampling of physicians, nurses and allied health staff working in three tertiary level hospitals. Verbatim transcripts were analysed using thematic content analysis to identify themes. Clinicians representing physicians, nurses and allied health staff working in three tertiary level hospitals completed four focus group interviews between May 2019 and July 2019. There were 50 participants, 28 men and 22 women including cardiologists, geriatricians, nurses, and allied health. The focus groups generated three overarching, interrelated themes: i) The current state of play, understanding the perceived challenges of patient cardiac monitoring in hospitals ii) Priorities in cardiac monitoring, what parameters should new technologies measure? iii) Cardiac monitoring of the future, ‘the ideal device’. There remain pitfalls related to the design of wearable cardiac technology for older adults which present clinical challenges. These pitfalls and challenges likely negatively impact uptake of wearable cardiac monitoring in routine clinical care. Partnering with clinicians and patients in the co-design of new wearable cardiac monitoring technologies is critical to optimise use and uptake in clinical care.

Biomarkers of Cardiac Health and Disease.

Cardiovascular diseases (CVDs) are globally associated with high rates of morbidity and mortality. CVDs are diagnosed based on clinical assessment, physical examination, disease history, electrocardiogram, and chest X-ray. However, these parameters have limited sensitivity and specificity. Furthermore, CVDs include a range of conditions and are characterized by a wide variation in symptoms. Some patients with CVDs can also be asymptomatic. Hence, biomarkers are required for CVD confirmatory diagnoses. Although various biomarkers are suggestive of different CVDs, most of them are not used clinically in CVD diagnosis. This is because a single molecule is not completely suitable for diagnosis, especially at an early stage, or these markers have not been exploited beyond study stages. Because CVDs globally affect millions of individuals, a method for confirmatory detection at onset is eagerly required for effective clinical management of patients. This review focuses on potential biomolecules that can indicate the presence of different CVDs and cardiac health status.

Group medical visits after heart failure hospitalization: Study protocol for a randomized-controlled trial

A primary goal of this research project is to better understand how shared medical appointments (SMAs) can improve the health status and decrease hospitalization and death for patients recently discharged with heart failure (HF) by providing education, disease state monitoring, medication titration, and social support to patients and their caregivers. We propose a 3-site randomized-controlled efficacy trial with mixed methods to test a SMA intervention, versus usual care. Patients within 12 weeks of a HF hospitalization will be randomized to receive either HF-SMA (intervention arm) with optional co-participation with their caregivers, versus usual care (control arm). The HF-SMA will be provided by a non-physician team composed of a nurse, a nutritionist, a health psychologist, a nurse practitioner and/or a clinical pharmacist and will consist of four sessions of 2-h duration that occur every other week for 8 weeks. Each session will start with an assessment of patient needs followed by theme-based disease self-management education, followed by patient-initiated disease management discussion, and conclude with break-out sessions of individualized disease monitoring and medication case management. The study duration will be 180 days for all patients from the day of randomization. The primary study hypothesis is that, compared with usual care, patients randomized to HF-SMA will experience better cardiac health status at 90 and 180 days follow-up. The secondary hypotheses are that, compared to usual care, patients randomized to HF-SMA will experience better overall health status, a combined endpoint of hospitalization and death, better HF self-care behavior, and lower B-type natriuretic peptide levels.

Abstract 104: Group Medical Visits versus Usual Care in Heart Failure: Clinical Trial Design &amp; Rationale

Objective: The literature has demonstrated that patient self-care behaviors in heart failure (HF) and health system factors play an important role in patients’ health status and hospitalization risk. Utilizing the Chronic Care Model, shared medical appointments (SMA) are a type of care delivery redesign that provides patient self-management and peer support in addition to clinician-led disease management. In this model, the SMA team consists of a nutritionist, cardiology nurse, health psychologist, and a non-physician prescribing provider. The session begins with an assessment of patient needs followed by pre-assigned theme-based education and individualized medication management. Methods and Expected Results: At two VA medical centers, we will randomize 375 patients within 6 weeks of discharge from a HF hospitalization to receive either SMA intervention (4 sessions over 8 weeks) versus usual care (individual provider appointments) for HF. Inclusion criteria are: not enrolled in other programs for HF care, &lt;2 hospitalizations last 6 months, left ventricular ejection fraction &lt;40%. We will use stratified block randomization with block sizes of 4 at each site to ensure balance of the stratified variables. At 180 days, we will determine whether HF patients who participate in HF-SMA, as compared to patients who receive usual care: 1) Experience better cardiac health status measured by Kansas City Cardiomyopathy Questionnaire (primary outcome), and overall health status (EQ5D, secondary outcome); 2) Have fewer hospitalization or death and 3) Experience improvement in intermediate outcomes: a) increase in HF Self-Care Index, and b) decrease in plasma BNP levels. For patients who underwent HF-SMA, we will also determine perceived benefits, areas in need of improvement, potential obstacles of implementation, and fidelity of the intervention across sites, by conducting (a) face-to-face interviews with patients and (b) telephone interviews with physicians and administrators. Using VA cost data, we will perform a cost-effectiveness analysis to inform future VA resource allocation. Conclusions: This trial will generate critical knowledge regarding the clinical and cost-effectiveness of SMA in HF patients to provide patient-centered care, improve health status, and reduce readmission for patients with HF. Further, the results of the formative evaluation will support future implementation of this novel intervention into routine clinical practice.