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1.
Cardiovasc Digit Health J ; 5(2): 78-84, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38765619

RESUMO

Background: Remote monitoring devices for atrial fibrillation are known to positively contribute to the diagnostic process and therapy compliance. However, automatic algorithms within devices show varying sensitivity and specificity, so manual double-checking of electrocardiographic (ECG) recordings remains necessary. Objective: The purpose of this study was to investigate the validity of the KardiaMobile algorithm within the Dutch telemonitoring program (HartWacht). Methods: This retrospective study determined the diagnostic accuracy of the algorithm using assessments by a telemonitoring team as reference. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and F1 scores were determined. Results: A total of 2298 patients (59.5% female; median age 57 ± 15 years) recorded 86,816 ECGs between April 2019 and January 2021. The algorithm showed sensitivity of 0.956, specificity 0.985, PPV 0.996, NPV 0.847, and F1 score 0.976 for the detection of sinus rhythm. A total of 29 false-positive outcomes remained uncorrected within the same patients. The algorithm showed sensitivity of 0.989, specificity 0.953, PPV 0.835, NPV 0.997, and F1 score 0.906 for detection of atrial fibrillation. A total of 2 false-negative outcomes remained uncorrected. Conclusion: Our research showed high validity of the algorithm for the detection of both sinus rhythm and, to a lesser extent, atrial fibrillation. This finding suggests that the algorithm could function as a standalone instrument particularly for detection of sinus rhythm.

2.
Circ Heart Fail ; 16(7): e010255, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37381923

RESUMO

BACKGROUND: Concentric remodeling (cRM) can precede heart failure with preserved ejection fraction (HFpEF), a condition prevalent in women. METHODS: Patients (n=60 593, 54.2% women) visiting outpatient clinics of Cardiology Centers of the Netherlands were analyzed for cRM, HFpEF development, and mortality risk. We studied risk factors for relative wall thickness both sex-stratified and in women and men combined. Biomarker profiling was performed (4534 plasma proteins) in a substudy involving 557 patients (65.4% women) to identify pathways involved in cRM. RESULTS: cRM was present in 23.5% of women and 27.6% of men and associated with developing HFpEF (HR, 2.15 [95% CI, 1.51-2.99]) and mortality risk (HR, 1.09 [95% CI, 1.00-1.19]) in both sexes. Age, heart rate, and hypertension were statistically significantly stronger risk factors for relative wall thickness in women than men. Higher circulating levels of IFNA5 (interferon alpha-5) were associated with higher relative wall thickness in women only. Pathway analysis revealed differential pathway activation by sex and increased expression of inflammatory pathways in women. CONCLUSIONS: cRM is prevalent in approximately 1 in 4 women and men visiting outpatient cardiology clinics and associated with HFpEF development and mortality risk in both sexes. Known risk factors for cRM were more strongly associated in women than men. Proteomic analysis revealed inflammatory pathway activation in women, with a central role for IFNA5. Differential biologic pathway activation by sex in cRM may contribute to the female predominance of HFpEF and holds promise for identification of new therapeutic avenues for prevention and treatment of HFpEF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT001747.


Assuntos
Insuficiência Cardíaca , Humanos , Masculino , Feminino , Insuficiência Cardíaca/tratamento farmacológico , Volume Sistólico/fisiologia , Caracteres Sexuais , Remodelação Ventricular/fisiologia , Proteômica , Função Ventricular Esquerda , Prognóstico
3.
Open Heart ; 9(2)2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36581377

RESUMO

OBJECTIVE: To assess the prognostic value of absolute and sex-specific, age-specific and race/ethnicity-specific (Multi-Ethnic Study of Atherosclerosis, MESA) percentiles of coronary artery calcification in symptomatic women and men. METHODS: The study population consisted of 4985 symptomatic patients (2793 women, 56%) visiting a diagnostic outpatient cardiology clinic between 2009 and 2018 who were referred for cardiac CT to determine Coronary Artery Calcium Score (CACS). Regular care data were used and these data were linked to the databases of Statistics Netherlands for all-cause mortality data. Kaplan-Meier curves, multivariate Cox proportional hazards regression and concordance statistics were used to evaluate the prognostic value of CACS and MESA percentiles. Women were older compared with men (60 vs 59 years). RESULTS: Median CACS was 0 (IQR: 0-54) in women and 42 (IQR: 0-54) in men. After a median follow-up of 4.4 years (IQR: 3.1-6.3), 116 (2.3%; 53 women and 63 men) patients died. MESA percentiles did not perform better compared with absolute CACS (C-statistic 0.65, 95% CI 0.57 to 0.73, vs 0.66, 95% CI 0.58 to 0.74, in women and 0.59, 95% CI 0.51 to 0.67, vs 0.62, 95% CI 0.55 to 0.69, in men, for the percentiles and absolute CACS, respectively). CONCLUSIONS: In symptomatic individuals absolute CACS predicts mortality with a moderately good performance. MESA percentiles did not perform better compared with absolute CACS, thus there is no need to use them. Including degree of stenosis in the model might slightly improve mortality risk prediction in women, but not in men.


Assuntos
Aterosclerose , Doença da Artéria Coronariana , Calcificação Vascular , Masculino , Humanos , Feminino , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/epidemiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/epidemiologia , Tomografia Computadorizada por Raios X , Prognóstico
4.
Ned Tijdschr Geneeskd ; 1662022 06 20.
Artigo em Holandês | MEDLINE | ID: mdl-35899736

RESUMO

Currently, risk prediction models like SCORE are used for decision making in the primary prevention of cardiovascular disease. The external validity of these models is questionable since they give rise to overtreatment with statins or antihypertensive drugs. Detailed individual risk assessment may reduce this drawback and will increase cost effectiveness. The CT derived coronary calcium score, in asymptomatic patients, was shown to be more accurate than the current prediction models. A coronary calcium score of zero reclassifies a significant number of individuals to a lower risk group and subsequently prevent overtreatment. Using this strategy, it can be anticipated that the Dutch healthcare costs can be reduced by at least 15 million Euro per year.


Assuntos
Cálcio , Doenças Cardiovasculares , Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Fatores de Risco de Doenças Cardíacas , Humanos , Prevenção Primária , Fatores de Risco , Tomografia Computadorizada por Raios X
5.
Eur Heart J ; 43(33): 3118-3128, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35708168

RESUMO

AIMS: The diagnostic performance of non-invasive imaging in patients with prior coronary artery disease (CAD) has not been tested in prospective head-to-head comparative studies. The aim of this study was to compare the diagnostic performance of qualitative single-photon emission computed tomography (SPECT), quantitative positron emission tomography (PET), and qualitative magnetic resonance imaging (MRI) in patients with a prior myocardial infarction (MI) or percutaneous coronary intervention (PCI). METHODS AND RESULTS: In this prospective clinical study, all patients with prior MI and/or PCI and new symptoms of ischaemic CAD underwent 99mTc-tetrofosmin SPECT, [15O]H2O PET, and MRI, followed by invasive coronary angiography with fractional flow reserve (FFR) in all coronary arteries. All modalities were interpreted by core laboratories. Haemodynamically significant CAD was defined by at least one coronary artery with an FFR ≤0.80. Among the 189 enrolled patients, 63% had significant CAD. Sensitivity was 67% (95% confidence interval 58-76%) for SPECT, 81% (72-87%) for PET, and 66% (56-75%) for MRI. Specificity was 61% (48-72%) for SPECT, 65% (53-76%) for PET, and 62% (49-74%) for MRI. Sensitivity of PET was higher than SPECT (P = 0.016) and MRI (P = 0.014), whereas specificity did not differ among the modalities. Diagnostic accuracy for PET (75%, 68-81%) did not statistically differ from SPECT (65%, 58-72%, P = 0.03) and MRI (64%, 57-72%, P = 0.052). Using FFR < 0.75 as a reference, accuracies increased to 69% (SPECT), 79% (PET), and 71% (MRI). CONCLUSION: In this prospective head-to-head comparative study, SPECT, PET, and MRI did not show a significantly different accuracy for diagnosing FFR defined significant CAD in patients with prior PCI and/or MI. Overall diagnostic performances, however, were discouraging and the additive value of non-invasive imaging in this high-risk population is questionable.


Assuntos
Doença da Artéria Coronariana , Reserva Fracionada de Fluxo Miocárdico , Imagem de Perfusão do Miocárdio , Intervenção Coronária Percutânea , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Imagem de Perfusão do Miocárdio/métodos , Valor Preditivo dos Testes , Estudos Prospectivos , Tomografia Computadorizada por Raios X
6.
Build Environ ; 220: 109254, 2022 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-35719131

RESUMO

Cardiac exercise stress testing (CEST) is an important diagnostic tool in daily cardiology practice. However, during intense physical activity microdroplet aerosols, potentially containing SARS-CoV-2 particles, can persist in a room for a long time. This poses a potential infection risk for the medical staff involved in CEST, as well as for the patients entering the same room afterwards. We measured aerosol generation and persistence, to perform a risk assessment for SARS-CoV-2 transmission through aerosols during CEST. We find that during CEST, the aerosol levels remain low enough that SARS-CoV-2 transmission through aerosols is unlikely, with the room ventilation system producing 14 air changes per hour. A simple measurement of CO2 concentration gives a good indication of the ventilation quality.

7.
JMIR Med Inform ; 10(1): e31063, 2022 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-35076407

RESUMO

BACKGROUND: Knowledge about adverse drug reactions (ADRs) in the population is limited because of underreporting, which hampers surveillance and assessment of drug safety. Therefore, gathering accurate information that can be retrieved from clinical notes about the incidence of ADRs is of great relevance. However, manual labeling of these notes is time-consuming, and automatization can improve the use of free-text clinical notes for the identification of ADRs. Furthermore, tools for language processing in languages other than English are not widely available. OBJECTIVE: The aim of this study is to design and evaluate a method for automatic extraction of medication and Adverse Drug Reaction Identification in Clinical Notes (ADRIN). METHODS: Dutch free-text clinical notes (N=277,398) and medication registrations (N=499,435) from the Cardiology Centers of the Netherlands database were used. All clinical notes were used to develop word embedding models. Vector representations of word embedding models and string matching with a medical dictionary (Medical Dictionary for Regulatory Activities [MedDRA]) were used for identification of ADRs and medication in a test set of clinical notes that were manually labeled. Several settings, including search area and punctuation, could be adjusted in the prototype to evaluate the optimal version of the prototype. RESULTS: The ADRIN method was evaluated using a test set of 988 clinical notes written on the stop date of a drug. Multiple versions of the prototype were evaluated for a variety of tasks. Binary classification of ADR presence achieved the highest accuracy of 0.84. Reduced search area and inclusion of punctuation improved performance, whereas incorporation of the MedDRA did not improve the performance of the pipeline. CONCLUSIONS: The ADRIN method and prototype are effective in recognizing ADRs in Dutch clinical notes from cardiac diagnostic screening centers. Surprisingly, incorporation of the MedDRA did not result in improved identification on top of word embedding models. The implementation of the ADRIN tool may help increase the identification of ADRs, resulting in better care and saving substantial health care costs.

8.
Curr Probl Cardiol ; 47(10): 100996, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34610350

RESUMO

Stroke prevention and rate or rhythm control are crucial in the management of atrial fibrillation (AF). There is recent evidence for benefit of early rhythm control, yet rate control is the first choice in elderly patients. However, the efficacy and safety of rate and rhythm control in the elderly population remains largely unexplored. Therefore, we analyzed electronic health record data and investigated prescribing patterns and mortality of both strategies in elderly patients with AF. Data from patients with AF who were aged ≥75 years, used a pharmacological rate or rhythm control strategy, and visited Cardiology Centers of the Netherlands between 2007 and 2018 were extracted. Of the 1497 patients (54% female), 316 (21%) were prescribed rhythm control and 1181 (79%) rate control. Patients aged >85 years (OR: 2.28; 95% CI: 1.51-3.44, P< 0.001) and those with permanent AF (OR: 2.71; 95% CI: 1.67-4.41, P< 0.001) were more likely to receive rate control, whereas those with paroxysmal AF were less likely to receive rate control (OR: 0.42; 95% CI: 0.32-0.56, P< 0.001). After correction for relevant confounders, the mortality risk for patients using rhythm control and patients using rate control was similar (HR: 0.89; 95% CI: 0.70-1.12, P = 0.31). A more liberal approach towards prescribing a rhythm control strategy to the elderly patients with AF may be warranted and seems safe. Our data underscore the need for prospective studies to provide definite answers on efficacy and safety of rhythm control in elderly patients with AF.


Assuntos
Fibrilação Atrial , Idoso , Antiarrítmicos , Estudos de Coortes , Progressão da Doença , Feminino , Humanos , Masculino , Estudos Observacionais como Assunto , Estudos Prospectivos
9.
Heart ; 108(17): 1361-1368, 2022 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34782405

RESUMO

OBJECTIVES: To investigate the impact of a CT-first strategy on all-cause and cardiovascular mortality in patients presenting with chest pain in outpatient cardiology clinics. METHODS: Patients with a first presentation of suspected angina pectoris were identified and their data linked to the registrations of Statistics Netherlands for information on mortality. The linked database consisted of 33 068 patients. CT-first patients were defined as patients with a CT calcium score and coronary CT angiography, within 6 weeks after their initial visit. Propensity score matching (1:5) was used to match patients with and without a CT-first strategy. After matching, 12 545 patients were included of which 2308 CT-first patients and 10 237 patients that underwent usual care. RESULTS: Mean age was 57 years, 56.3% were women and median follow-up was 4.9 years. All-cause mortality was significantly lower in CT-first patients (n=43, 1.9%) compared with patients without CT (n=363, 3.5%) (HR: 0.51, 95% CI 0.37 to 0.70). Furthermore, CT-first patients were more likely to receive cardiovascular preventative and antianginal medication (aspirin: 44.9% vs 27.1%, statins: 48.7% vs 30.3%, beta-blockers: 37.8% vs 25.5%, in CT-first and without CT-first patients, respectively) and to undergo downstream diagnostics and interventions (coronary interventions: 8.5% vs 5.7%, coronary angiography: 16.2% vs 10.6% in CT-first and without CT-first patients, respectively). CONCLUSIONS: In a real-world regular care database, a CT-first strategy in patients suspected of angina pectoris was associated with a lowering of all-cause mortality.


Assuntos
Doença da Artéria Coronariana , Angina Pectoris/complicações , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/terapia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X/métodos
10.
Eur J Prev Cardiol ; 28(14): 1579-1587, 2021 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-34929044

RESUMO

BACKGROUND: eHealth programs can lower blood pressure but also drive healthcare costs. This study aims to review the evidence on the effectiveness and costs of eHealth for hypertension and assess commonalities in programs with high effect and low additional cost. RESULTS: Overall, the incremental decrease in systolic blood pressure using eHealth, compared to usual care, was 3.87 (95% confidence interval (CI) 2.98-4.77) mmHg at 6 months and 5.68 (95% CI 4.77-6.59) mmHg at 12 months' follow-up. High intensity interventions were more effective, resulting in a 2.6 (95% CI 0.5-4.7) (at 6 months) and 3.3 (95% CI 1.4-5.1) (at 12 months) lower systolic blood pressure, but were also more costly, resulting in €170 (95% CI 56-284) higher costs at 6 months and €342 (95% CI 128-556) at 12 months. Programs that included a high volume of participants showed €203 (95% CI 99-307) less costs than those with a low volume at 6 months, and €525 (95% CI 299-751) at 12 months without showing a difference in systolic blood pressure. Studies that implemented eHealth as a partial replacement, rather than addition to usual care, were also less costly (€119 (95% CI -38-201 at 6 months) and €346 (95% CI 261-430 at 12 months)) without being less effective. Evidence on eHealth programs for hypertension is ambiguous, heterogeneity on effectiveness and costs is high (I2 = 56-98%). CONCLUSION: Effective eHealth with limited additional costs should focus on high intensity interventions, involve a large number of participants and use eHealth as a partial replacement for usual care.


Assuntos
Hipertensão , Telemedicina , Pressão Sanguínea , Humanos , Hipertensão/diagnóstico , Hipertensão/terapia , Telemedicina/métodos
11.
Heart ; 107(21): 1748-1755, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34261736

RESUMO

OBJECTIVE: Women with heart failure with reduced ejection fraction (HFrEF) may reach optimal treatment effect at half of the guideline-recommended medication dose. This study investigates prescription practice and its relation with survival of patients with HF in daily care. METHODS: Electronic health record data from 13 Dutch outpatient cardiology clinics were extracted for HF receiving at least one guideline-recommended HF medication. Dose changes over consecutive prescriptions were modelled using natural cubic splines. Inverse probability-weighted Cox regression was used to assess the relationship between dose (reference≥50% target dose) and all-cause mortality. RESULTS: The study population comprised 561 women (29% HFrEF (ejection fraction (EF)<40%), 49% heart failure with preserved ejection fraction (EF≥50%); HFpEF and 615 men (47% and 25%, respectively). During a median follow-up of 3.7 years, 252 patients died (48% women; 167 HFrEF, 84 HFpEF). Nine hundred thirty-four patients (46% women) received ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 795 (48% women) beta blockers and 178 (42% women) mineralocorticoid receptor antagonists (MRAs). In both sexes, the mean target dose across prescriptions was 50% for ACEI/ARBs and beta blockers, and 100% for MRAs. ACEI/ARB dose of <50% was associated with lower mortality in women but not in men with HFrEF. This was not seen in patients with HFpEF. Beta-blocker dose was not associated with all-cause mortality. CONCLUSION: Patients with HF seen in outpatient cardiology clinics receive half of the guideline-recommended medication dose. Lower ACEI/ARB dose was associated with improved survival in women with HFrEF. These results underscore the importance of (re)defining optimal medical therapy for women with HFrEF.


Assuntos
Antagonistas Adrenérgicos beta/administração & dosagem , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Antagonistas de Receptores de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Antagonistas de Receptores de Mineralocorticoides/administração & dosagem , Função Ventricular Esquerda/fisiologia , Idoso , Causas de Morte/tendências , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Fidelidade a Diretrizes , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Países Baixos/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Volume Sistólico/fisiologia , Taxa de Sobrevida/tendências
12.
BMC Cardiovasc Disord ; 21(1): 287, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112101

RESUMO

BACKGROUND: Despite the increasing availability of clinical data due to the digitalisation of healthcare systems, data often remain inaccessible due to the diversity of data collection systems. In the Netherlands, Cardiology Centers of the Netherlands (CCN) introduced "one-stop shop" diagnostic clinics for patients suspected of cardiac disease by their general practitioner. All CCN clinics use the same data collection system and standardised protocol, creating a large regular care database. This database can be used to describe referral practices, evaluate risk factors for cardiovascular disease (CVD) in important patient subgroups, and develop prediction models for use in daily care. CONSTRUCTION AND CONTENT: The current database contains data on all patients who underwent a cardiac workup in one of the 13 CCN clinics between 2007 and February 2018 (n = 109,151, 51.9% women). Data were pseudonymised and contain information on anthropometrics, cardiac symptoms, risk factors, comorbidities, cardiovascular and family history, standard blood laboratory measurements, transthoracic echocardiography, electrocardiography in rest and during exercise, and medication use. Clinical follow-up is based on medical need and consisted of either a repeat visit at CCN (43.8%) or referral for an external procedure in a hospital (16.5%). Passive follow-up via linkage to national mortality registers is available for 95% of the database. UTILITY AND DISCUSSION: The CCN database provides a strong base for research into historically underrepresented patient groups due to the large number of patients and the lack of in- and exclusion criteria. It also enables the development of artificial intelligence-based decision support tools. Its contemporary nature allows for comparison of daily care with the current guidelines and protocols. Missing data is an inherent limitation, as the cardiologist could deviate from standardised protocols when clinically indicated. CONCLUSION: The CCN database offers the opportunity to conduct research in a unique population referred from the general practitioner to the cardiologist for diagnostic workup. This, in combination with its large size, the representation of historically underrepresented patient groups and contemporary nature makes it a valuable tool for expanding our knowledge of cardiovascular diseases. TRIAL REGISTRATION: Not applicable.


Assuntos
Assistência Ambulatorial , Serviço Hospitalar de Cardiologia , Bases de Dados Factuais , Cardiopatias/terapia , Ambulatório Hospitalar , Projetos de Pesquisa , Idoso , Mineração de Dados , Feminino , Pesquisa sobre Serviços de Saúde , Fatores de Risco de Doenças Cardíacas , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Padrões de Prática Médica , Prevalência , Prognóstico , Encaminhamento e Consulta , Medição de Risco , Fatores de Tempo
14.
Eur Heart J Digit Health ; 2(2): 224-230, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36712387

RESUMO

Aims: There is limited quantitative evidence on the effect of symptom-driven telemonitoring for cardiac arrhythmias on patient-reported outcomes. We evaluated the effect of a symptom-driven remote arrhythmia monitoring programme on the patient-reported health-related quality of life (HRQoL), sense of safety, physical limitations, and self-management. Methods and results: This was an observational retrospective longitudinal study of the symptom-driven HartWacht-telemonitoring programme using a remote single-lead electrocardiogram monitoring system. Real-world patient data from participants who were enrolled in the telemonitoring programme for (suspected) symptomatic atrial fibrillation (AF) between July 2017 and September 2019 were evaluated. Primary outcomes were the patient-reported generic HRQoL, disease-specific HRQoL, sense of safety, physical limitations, and self-management at date of enrolment, 3 months and 6 months of follow-up. Outcomes were compared to a historical control group consisting of AF patients receiving standard care. A total of 109 participants in the HartWacht programme [59 men (54%); mean age 61 ± 11 years; 72% diagnosed AF] were included in complete case analysis. There was no significant change in HRQoL and sense of safety during follow-up. A significant improvement in the perceived physical limitations was observed. The level of self-management declined significantly during follow-up. Comparisons to the historic control group (n = 83) showed no difference between the patient-reported disease-specific HRQoL, sense of safety and physical limitations at 6 months of follow-up. Conclusion: Symptom-driven remote arrhythmia monitoring for AF does not seem to affect HRQoL and sense of safety, whereas the perceived physical limitations tend to improve. Patient-reported self-management declined during the first 6 months of participation.

15.
Phys Fluids (1994) ; 32(12): 121707, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33362399

RESUMO

We measure aerosol persistence to assess the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in public spaces. Direct measurement of aerosol concentrations, however, has proven to be technically difficult; we propose the use of handheld particle counters as a novel and easily applicable method to measure aerosol concentrations. This allows us to perform measurements in typical public spaces, each differing in volume, the number of people, and the ventilation rate. These data are used to estimate the relation between the aerosol persistence time and the risk of infection with SARS-CoV-2.

16.
Phys Fluids (1994) ; 32(10): 107108, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33154612

RESUMO

Transmission of SARS-CoV-2 leading to COVID-19 occurs through exhaled respiratory droplets from infected humans. Currently, however, there is much controversy over whether respiratory aerosol microdroplets play an important role as a route of transmission. By measuring and modeling the dynamics of exhaled respiratory droplets, we can assess the relative contribution of aerosols to the spreading of SARS-CoV-2. We measure size distribution, total numbers, and volumes of respiratory droplets, including aerosols, by speaking and coughing from healthy subjects. Dynamic modeling of exhaled respiratory droplets allows us to account for aerosol persistence times in confined public spaces. The probability of infection by inhalation of aerosols when breathing in the same space can then be estimated using current estimates of viral load and infectivity of SARS-CoV-2. The current known reproduction numbers show a lower infectivity of SARS-CoV-2 compared to, for instance, measles, which is known to be efficiently transmitted through the air. In line with this, our study of transmission of SARS-CoV-2 suggests that aerosol transmission is a possible but perhaps not a very efficient route, in particular from non-symptomatic or mildly symptomatic individuals that exhibit low viral loads.

19.
Int J Med Inform ; 132: 104011, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31654966

RESUMO

BACKGROUND: Adults with congenital heart disease (ACHD) often suffer from deterioration related to cardiac arrhythmias, hypertension (HT) or heart failure (HF), frequently occurring between planned visits. Mobile health (mHealth) could improve management through remote monitoring by enabling swift therapeutic response and detecting new diagnoses. METHODS: We performed a prospective study employing mHealth in ACHD patients, weekly monitoring heart rhythm, weight and blood pressure. In case of consecutive threshold exceeding measurements or in case of new diagnosis, patients were contacted and if needed the treating physician was consulted. Inclusion criteria were: palpitations within the last three years (with or without arrhythmia diagnosis) or HF NYHA class ≥ II. We evaluated the detection of recurrences and new diagnosis of arrhythmias, HT and HF, adherence and patient experience (Net Promotor Score (NPS)). RESULTS: In total, 109 of the 268 invited ACHD patients were enrolled, 80 with palpitations, 13 with HF, 16 experienced both, mean age 45 (±13) years, 33% male. Median follow-up was 12 (Q1-Q3;9-14) months, 91 patients initiated all measurements (heart rhythm, weight and blood pressure). In 25% of the patients with diagnosed arrhythmias (14/56) recurrences of arrhythmias were detected; 13% of the patients with undiagnosed palpitations (4/32) were diagnosed with novel arrhythmias. In 38% of the patients with HT at baseline (6/16), treatment adjustment was necessary, 4% of the patients without HT (4/76) received novel HT diagnosis. Diuretics were adjusted in 7% of the patients with HF (2/29). Adherence was > 70% in 77% of the patients that started weekly measurements (70/91). Patients that were female, older of age and experienced palpitations at inclusion were more likely to acquire an adherence of > 70%. NPS was completed by 68 patients, 57 patients (84%) were promotors or neutral, and 11 patients (16%) were critics. CONCLUSIONS: mHealth offers advantages in the management of selected ACHD patients; it enabled early detection of recurrences and new diagnosis of arrhythmias, hypertension and heart failure, which lead to swift therapeutic response or remote reassurance. Furthermore, mHealth was well accepted with high adherence and positive patient experience.


Assuntos
Arritmias Cardíacas/prevenção & controle , Cardiopatias Congênitas/complicações , Insuficiência Cardíaca/prevenção & controle , Hipertensão/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Telemedicina/métodos , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/etiologia , Gerenciamento Clínico , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Telemedicina/estatística & dados numéricos
20.
Expert Rev Cardiovasc Ther ; 16(9): 627-634, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30079780

RESUMO

INTRODUCTION: Mobile health (mHealth), an advanced form of eHealth is expected to drastically change the field of traditional healthcare in the near future as wearables and mobile applications are rapidly increasing in number. The majority of patients with congenital heart disease (CHD) now reach adulthood and this relative young patient population seems particularly suited for mHealth, as they require lifelong follow-up, experience high morbidity burden, and were raised in this digital era. In patients with acquired heart disease the potential of eHealth has been demonstrated, yet data are still inconclusive. Areas covered: In this review of the current literature we evaluated the effect of various eHealth interventions in patients with CHD. Our search resulted in a mere 10 studies, which comprised mostly of children or adolescents with severe CHD. Home-monitoring of saturation and weight through mHealth was found to be beneficial in patients after palliation procedures, and video conferencing was found to have a positive effect on anxiety and healthcare utilization. Expert commentary: Due to high morbidity and mortality in patients with CHD and the promising results of eHealth interventions, further research is desperately needed.


Assuntos
Atenção à Saúde/métodos , Cardiopatias Congênitas/terapia , Telemedicina/métodos , Adolescente , Adulto , Criança , Humanos
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