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Year | Objective | Key Message(s) |
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2023 |
To (1) analyze the SoMe Twitter network behind #TeleCheckAF, (2) describe the communities and behavioral groups within the network and (3) to determine the opinion leaders and influencers. |
The SoMe network behind #TeleCheckAF showed a wide dissemination involving a broad spectrum of healthcare professionals and was accelerated by the official ESC Twitter handles. Social network analysis created a helpful insight into the mechanisms behind innovation dissemination within social media. Future research could further analyze the difssemination process using e.g. hazard modeling and investigate the evolution of the network and behaviors over time. |
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How to use digital devices to detect and manage arrhythmias: an EHRA practical guide | 2022 |
The aim of the document is to provide up-to-date practical guidance on the use of digital devices for arrhythmias, from early detection through management and implementation, using the categories of consensus. |
Overall digital devices for heart rhythm monitoring are abundant, and with the rapid advancement of technologies likely to increase further. In the future, a digital workflow will likely be implemented at most cardiology clinics, and the devices available will likely have additional monitoring capabilities and features. |
Mobile Health zur Detektion von Vorhofflimmern – Status quo und Perspektiven
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2022 | - | - |
2022 | To summarize technical aspects and clinical purposes of DiHA for the detection of AFib. | There is ample evidence pointing to high accuracy of DiHA for the detection of AFib (analytical validation). While ECG-based algorithms often require additional sensors, PPG utilizes techniques integrated in smartphones or smartwatches. The advantage for clinical use results from the widespread accessibility for rhythm monitoring, allowing for earlier diagnosis and higher detection rates of AFib. Most available studies indicate a benefit for the use of DiHA.However, the evidence regarding hard clinical endpoints and positive care effects (clinical validation) still requires improvement. |
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2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management Digital Medical Tools for Heart Rhythm Professionals
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2021 | To describe the current status of mobile health technologies in arrhythmia management. | Several key characteristics of AF can be measured with long-term continuous or near-continuous monitoring, and the information gained may provide valuable information for patient management. mHealth extends AF screening to younger patients without cardiovascular disease, and thrombo-embolic potential may be low. |
2021 | To determine the several aspects of AF-screening (why, theoretical approach of strategies, who, how, duration, intensity, pitfalls and future). | AF detection rate of screening is determined by the population, the tool, the frequency, and the duration of screening. In general, longer and more frequent screening in a population at higher risk for AF results in a higher detection rate. Implantable cardiac rhythm devices have the highest AF detection rates. Single-lead ECG and PPG devices are potentially more cost-effective and are more convenient for population-wide screening |
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2021 | To systematically review the available literature on mobile Health (mHealth) solutions, including handheld and wearable devices, implantable loop recorders (ILRs), as well as mobile platforms and support systems in atrial fibrillation (AF) detection and management | There is already some data demonstrating that PPG technology is nearly as accurate as ECG to detect AF. The studies which used randomly selected, mostly, low-risk populations, reported the lowest accuracy for AF detection, whereas those focused on AF screening among high-risk and/or elderly populations, reported the highest sensitivity and specificity for AF detection. More targeted population selection and identifying those patients at higher risk of AF by using specific biomarkers is a reasonable way to boost the pre-test, hence reduce false-positive results, especially among populations that are not represented by the usual risk scores (especially CHADS2 and CHA2DS2-VASc). |
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2020 | To determine the accuracy of smartphone camera applications that diagnose and screen for AF and to determine which application is the most accurate. | All smartphone camera applications individually had a high sensitivity and specificity, and this remained true for the meta-analyzed estimate for all applications collectively. It would be interesting to examine whether the PPV would improve if these applications were used to screen a further selective high-risk population, for instance among patients with a CHA2DS2-VASc score of at least 3, those at high genetic risk or with chronic AF. There seemed to be 3 clinical situations in which these applications could be used (or are currently being used), as follows: as a screening tool, as a diagnostic test, and/or as a monitoring device. It remains unclear whether patients with AF uncovered via screening would benefit from receiving anticoagulation medication. |
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2020 | To conduct a systematic review of the literature (43 studies) and summarize the performance of mHealth devices in diagnosing and screening for AF. | The performance of mHealth devices in detecting AF depends on the characteristics of the population being studied, their risk of developing AF, and the technology used to detect AF. The lower specificity achieved by PPG algorithm in comparison to AliveCor algorithms may be explained by finger movement artifacts that can affect the detection algorithm, leading to a reduction in specificity when the smartphone application is used outside the clinic. Pulse palpation can result in greater false-positive cases by falsely assigning a diagnosis of AF to patients with transient pulse irregularities. The use of 12-lead ECG for screening purposes is limited by its lack of portability and holters have a high cost. Mobile health devices offer a feasible option for mass screening of AF in diverse settings as they are user-friendly, leadless, and widely used by the general population. |
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2020 | Explaining the coordination of the TeleCheck-AF approach and the implementation of this mHealth intervention in European centers. | The TeleCheck-AF approach was a significant source of support and reassurance for both patients and health care providers. Coordination appeared to be a key concept, intertwined with numerous aspects of the mHealth infrastructure: from empowering patients to self-manage the on-demand application, to implementation of the approach in clinical centers, aiming to strengthen the health system response toCOVID-19. |
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2020 | - | TeleCheck-AF is a user-friendly and short intervention that puts the patient ‘in charge’ of their care by delivering vital data which may also result in better adherence to the treatment regime. The data provided by the patient are stored in a cloud, are easily accessible and provides the healthcare professional with an overview of heart rhythm and rate as well as whether the patient has experienced AF-related symptoms. |
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2020 | To describe the components and implementation of the TeleCheck-AF approach in an integrated and specialized AF-clinic through teleconsultation during COVID-19. | The patient is actively involved in the treatment trajectory by monitoring heart rate and rhythm information, as well as blood pressure and weight measures. Education about AF management and the importance of lifestyle and risk factor management is provided. The app is a true example of mHealth impacting both the patient as well as the health care professional. During COVID-19, remote adaptation of rate and rhythm medication guided by the on-demand monitoring infrastructure are elemental parts of TeleCheck-AF. |
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2020 | To monitor rate and rhythm remotely just around teleconsultations to allow a better assessment of the dis-ease state of the patient and to support treatment decisions. This on-demand approach was regulated by a prescription to use the app for a limited predefined time period, which avoids unnecessary data-load and additional follow-up patients-contacts. | The relatively low cost, convenience, and broad accessibility of the mobile phone app used in this approach allows a fast and broad implementation of the described mHealth infrastructure during the COVID-19 pandemic. A potential disadvantage is that no electrocardiogram is provided. It is feasible to implement a novel app-based on-demand rhythm and rate monitoring infrastructure to efficiently provide teleconsultations in an AF population. |
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2020 | To discuss mobile health (mHealth) tools and strategies to remotely monitor heart rate and rhythm and incorporate AF risk factors assessment to allow comprehensive AF management through teleconsultation. Additionally, as a possible solution to improve remote AF care during the COVID-19 pandemic, the on-demand TeleCheck-AF mHealth approach allows remote app-based assessment of heart rate and rhythm around teleconsultations | During the COVID-19 pandemic there is decreased capacity to see patients in the outpatient clinic and mHealth has become an important component of many AF outpatient clinics. mHealth technologies can be used for (semi-)continuous longitudinal monitoring or for short-term on-demand monitoring, depending on the respective requirements and clinical scenarios. Large scale international mHealth projects, such as TeleCheck-AF, will provide insight into the additional value and potential limitations of mHealth strategies to remotely manage AF patients. Such mHealth infrastructures may be well suited within an integrated AF-clinic, which may require redesign of practice and reform of health care systems. |
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2020 | To inform about Telecheck-AF and the progress of the TeleCheck-AF project during the COVID-19 pandemic and to invite other centres to participate. | To guarantee the continuity of comprehensive AF management through teleconsultation during COVID-19, a mobile health (mHealth) intervention was developed at the university of Maastricht. An mHealth prescription (QR-code) activates the app and links the app toa secure cloud accessible by the treating physician. The primary focus of the project is to maintain AF management while keeping patients out of hospital during COVID-19. Since the launch of the project, 23 European hospitals across nine countries have joined the project |
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2020 | To define the specific data required for physicians to make clinical decisions by conducting a second survey. To define data quality required to take clinical decisions based on wearable device recordings and which data is important. To describe actual handling of these technologies in the context of current guidelines and identify gaps in current evidence to delineate the need for future guideline recommendations. To evaluate how the COVID-19 pandemic influenced the use of wearable devices and teleconsultations. | The study demonstrated that physicians: would diagnose AF and take therapeutic steps based on a single-lead ECG state that wearable rhythm-device ECG technology is suitable for AF screening, arrhythmia diagnostics, and patient monitoring, believe in the large potential of AI for the future of AF diagnostics and clinical decision making regarding oral anticoagulation point out that there is lack of reimbursement or information about reimbursement when dealing with wearable device rhythm recordings believe that costs for wearable rhythm devices should be shared between patients and the health insurer or government believe that teleconsultations in the future will remain at the same level as during the COVID-19 pandemic |
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2020 | To assess impact of these technologies on physicians' clinical decision-making regarding initiation of diagnostic steps, drug therapy, and invasive strategies. | Most physicians would consider a wearable device recording sufficient to start anticoagulation. Although sensitivity and specificity of PPG tracings are comparable to single-lead ECGs, physicians would rather make clinical decisions based on single-lead ECGs. Physicians also would be more reluctant to prescribe anticoagulation in asymptomatic patients, although stroke risk in patients with AF is not linked to symptoms of AF. Further studies and consensus is required on when and whom to anticoagulate based on wearable device rhythm recordings. |
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2020 | To generate insights into current practices and opinions of healthcare practitioners (HCPs) regarding using digital devices for AF management |
Cardiac electrophysiologists were more likely to have recommended the use of a digital device compared to other HCPs, and those in private practice were more likely to do so than practitioners in university hospital settings. |
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