Using Personal Activity Intelligence With Patients in a Clinic Setting: A Feasibility Study.

BACKGROUND: Personal Activity Intelligence (PAI) is a novel heart-rate-based metric used to assess cardiorespiratory fitness and quantify physical activity. OBJECTIVE: The aim of this study was to examine the feasibility, acceptability, and effectiveness of PAI with patients in a clinic setting. METHODS: Patients (n = 25) from 2 clinics underwent 12 weeks of heart-rate-monitored physical activity interfaced with aPAI Health phone app. We used a pre-post design with the Physical Activity Vital Sign and the International Physical Activity Questionnaire. Feasibility, acceptability, and PAI measures were used to evaluate the objectives. RESULTS: Twenty-two patients (88%) completed the study. There were significant improvements in International Physical Activity Questionnaire metabolic equivalent task minutes per week ( P = .046) and a decrease in sitting hours ( P = .0001). The Physical Activity Vital Sign activity increase in minutes per week was not significant ( P = .214). Patients achieved a mean PAI score of 116 ± 81.1 and 100 or greater 71% of the days. Most patients (81%) expressed satisfaction with PAI. CONCLUSIONS: Personal Activity Intelligence is feasible, acceptable, and effective when used with patients in a clinic setting.

Utilization of Chest Pain Decision Aids in a Community Hospital Emergency Department: A Mixed-methods Implementation Study.

INTRODUCTION: Chest pain is a common reason for emergency department (ED) visits. Evidence-based decision aids assessing risk for an adverse cardiac event are underused in community hospital emergency care. This study explored the acceptability, barriers, facilitators, and potential strategies for implementation of the HEART Score risk stratification tool, accelerated diagnostic pathway, and shared decision-making visual aid with physicians and chest pain patients ages >45 in a community hospital ED. METHODS: Single center, mixed-methods study. (1) Physician semistructured interviews using The Consolidated Framework for Implementation Research for systematic analysis. (2) Patient and physician surveys. (3) 16-week intervention of physician training and pilot testing of decision aids with ED patients. RESULTS: Physician interviews (n = 19); key facilitators: electronic medical record decision support, ease of use, risk stratification and disposition support, and shared decision-making training. Key barriers: time constraints, patient ability, and/or willingness to participate in shared decision-making, lack of integration with medical record and change in practice workflow. Patient study participants (n = 184) with a survey response rate of 92% (n = 170). Most patients (85%) were satisfied with the shared decision-making visual aid. Physicians surveyed (n = 84) with a response rate of 50% (n = 42). Most physicians, 95% (n = 40), support use of the HEART Score, with limited acceptance of the shared decision-making visual aid of 57% (n = 24). CONCLUSIONS: Using evidence-based chest pain decision aids in a community hospital ED is feasible and acceptable. Key barriers and facilitators for implementation were identified. Further research in community hospitals is needed to verify findings, examine generalizability, and test implementation strategies.

Exercise Training in Patients With Heart Failure With Preserved Ejection Fraction: A Community Hospital Pilot Study.

BACKGROUND: Patients with heart failure with preserved ejection fraction (HFpEF) experience poor exercise tolerance and quality of life. Little is known about the feasibility or effects of HFpEF exercise training (ET) in a community hospital setting. OBJECTIVE: The aim of this study was to examine the feasibility and pilot data of a community-based HFpEF ET intervention. METHODS: This was a single-group (n = 16), pretest-posttest, 9-week ET intervention. The Minnesota Living With Heart Failure Questionnaire, Patient Health Questionnaire-9, cardiopulmonary exercise test (peak VO2), and 6-minute walk test were used for evaluation. RESULTS: Participants (n = 16) attended 88% of prescribed ET sessions and 94% completed all pretest-posttest assessments. Significant improvements in Minnesota Living With Heart Failure Questionnaire (P = .01), Patient Health Questionnaire-9 (P ≤ .01), exercise test time (P = .01) and 6-minute walk test (P = .001), but not in peak VO2 (P = .16), were found. CONCLUSIONS: The ET intervention was feasible and safe, and findings support improved quality of life, depressive symptoms, and exercise tolerance. Larger controlled trials are warranted.