A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health Device Assessments in Modern Structural Heart Disease Clinics
| Autor: | Sanjeev P. Bhavnani, Srikanth Sola, David Adams, Ashwin Venkateshvaran, P.K. Dash, Partho P. Sengupta, Sanjeev Bhavnani, Thomas Ryan, Jagat Narula, James Thomas, Roberto Lang, Patricia Pellikka, Voleti Choudhary, V. Ramnath Iyer, Banajit Barooah, Reeta Varyani, Anand Lingan, Venkatesh Murugan, Prayaag Kini, N. Srinivas, Asha C. Barooah, G.V.R. Subbarao, C. Shivakumar, M. Subramaniyan, Shantanu P. Sengupta, Manish Bansal, Abdul Rahaman, Vijaysinh N. Patil, Narayana R. Kumar, Mohammad Y. Gahlot, Imran M. Damani, Rahul Gulati, Shreedhar S. Joshi, Sanjay Dubey, Jesu Krupa, Sara Irfan, R.B. Vidhyakar, Narendra Bidarkar, B.K. Shantesh, Swapna S. Chavan, R. Chandramohan, Vijaya Kumar, Shilpi Tirkey, Guru Prasad, Shivaprakash S. Lakshmana, Ramesh M. Malkar, V. Manjunath, Kiran Kumar Reddy, L.G. Ramesha, Sunita Kumbhalkar, Jyoti A. Thadlani, T.M. Nawaz Basha, Syed A. Hafeez, V. Leelavathi, Robin Mathews, Melissa Daubert, Jayne Cleve, Egle Burdulis, Natalie Fauss, Georgeanne Lammertin, Bharatbhushan Patel, Evelina Petrovets, Dipti Shah, Kara Thurmond, David Tomberlin, Hemavathi Umamaheswar, Ankita Kadakia |
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| Rok vydání: | 2017 |
| Předmět: |
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Time Factors Heart disease medicine.medical_treatment Heart Valve Diseases 030204 cardiovascular system & hematology Severity of Illness Index law.invention Electrocardiography 0302 clinical medicine Randomized controlled trial Valve replacement law Clinical endpoint 030212 general & internal medicine Oximetry mHealth Referral and Consultation Heart Valve Prosthesis Implantation Signal Processing Computer-Assisted Equipment Design Middle Aged Prognosis Mobile Applications Telemedicine Treatment Outcome Female Smartphone Cardiology and Cardiovascular Medicine Wireless Technology Adult Balloon Valvuloplasty medicine.medical_specialty Referral Point-of-Care Systems India Clinical decision support system Time-to-Treatment 03 medical and health sciences Young Adult Predictive Value of Tests medicine Humans Radiology Nuclear Medicine and imaging business.industry Rheumatic Heart Disease Blood Pressure Determination medicine.disease Actigraphy United States Echocardiography Doppler Color Clinical trial Physical therapy business |
| Zdroj: | JACC. Cardiovascular imaging. 11(4) |
| ISSN: | 1876-7591 |
| Popis: | This study sought to determine whether mobile health (mHealth) device assessments used as clinical decision support tools at the point-of-care can reduce the time to treatment and improve long-term outcomes among patients with rheumatic and structural heart diseases (SHD).Newly developed smartphone-connected mHealth devices represent promising methods to diagnose common diseases in resource-limited areas; however, the impact of technology-based care on long-term outcomes has not been rigorously evaluated.A total of 253 patients with SHD were randomized to an initial diagnostic assessment with wireless devices in mHealth clinics (n = 139) or to standard-care (n = 114) in India. mHealth clinics were equipped with point-of-care devices including pocket-echocardiography, smartphone-connected-electrocardiogram blood pressure and oxygen measurements, activity monitoring, and portable brain natriuretic peptide laboratory testing. All individuals underwent comprehensive transthoracic echocardiography to assess the severity of SHD. The primary endpoint was the time to referral for therapy with percutaneous valvuloplasty or surgical valve replacement. Secondary endpoints included the probability of a cardiovascular hospitalization and/or death over 1 year.An initial mHealth assessment was associated with a shorter time to referral for valvuloplasty and/or valve replacement (83 ± 79 days vs. 180 ± 101 days; p 0.001) and was associated with an increased probability for valvuloplasty/valve replacement compared to standard-care (34% vs. 32%; adjusted hazard ratio: 1.54; 95% CI: 0.96 to 2.47; p = 0.07). Patients randomized to mHealth were associated with a lower risk of a hospitalization and/or death on follow-up (15% vs. 28%, adjusted hazard ratio: 0.41; 95% CI: 0.21 to 0.83; p = 0.013).An initial mHealth diagnostic strategy was associated with a shorter time to definitive therapy among patients with SHD in a resource-limited area and was associated with improved outcomes. (A Randomized Trial of Pocket-Echocardiography Integrated Mobile Health Device Assessments in Modern Structural Heart Disease Clinics; NCT02881398). |
| Databáze: | OpenAIRE |
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