Background: Unplanned readmissions after hospitalization for acute myocardial infarction (AMI) are among the leading causes of preventable morbidity, mortality, and healthcare costs. Digital health interventions (DHI) could be an effective tool in promoting self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction. A DHI developed at Johns Hopkins-the Corrie Health Digital Platform (Corrie)-includes the first cardiology Apple CareKit smartphone application, which is paired with an Apple Watch and iHealth Bluetoothenabled blood pressure cuff. Corrie targets: (1) self-management of cardiac medications, (2) self-*
Background: Thirty-day readmissions among patients with acute myocardial infarction (AMI) contribute to the US health care burden of preventable complications and costs. Digital health interventions (DHIs) may improve patient health care self-management and outcomes. We aimed to determine if patients with AMI using a DHI have lower 30-day unplanned all-cause readmissions than a historical control. Methods: This nonrandomized controlled trial with a historical control, conducted at 4 US hospitals from 2015 to 2019, included 1064 patients with AMI (DHI n=200, control n=864). The DHI integrated a smartphone application, smartwatch, and blood pressure monitor to support guideline-directed care during hospitalization and through 30-days post-discharge via (1) medication reminders, (2) vital sign and activity tracking, (3) education, and (4) outpatient care coordination. The Patient Activation Measure assessed patient knowledge, skills, and confidence for health care self-management. All-cause 30-day readmissions were measured through administrative databases. Propensity score–adjusted Cox proportional hazard models estimated hazard ratios of readmission for the DHI group relative to the control group. Results: Following propensity score adjustment, baseline characteristics were well-balanced between the DHI versus control patients (standardized differences <0.07), including a mean age of 59.3 versus 60.1 years, 30% versus 29% Women, 70% versus 70% White, 54% versus 54% with private insurance, 61% versus 60% patients with a non ST-elevation myocardial infarction, and 15% versus 15% with high comorbidity burden. DHI patients were predominantly in the highest levels of patient activation for health care self-management (mean score 71.7±16.6 at 30 days). The DHI group had fewer all-cause 30-day readmissions than the control group (6.5% versus 16.8%, respectively). Adjusting for hospital site and a propensity score inclusive of age, sex, race, AMI type, comorbidities, and 6 additional confounding factors, the DHI group had a 52% lower risk for all-cause 30-day readmissions (hazard ratio, 0.48 [95% CI, 0.26–0.88]). Similar results were obtained in a sensitivity analysis employing propensity matching. Conclusions: Our results suggest that in patients with AMI, the DHI may be associated with high patient activation for health care self-management and lower risk of all-cause unplanned 30-day readmissions. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03760796.
A B S T R A C TFeral cats (Felis catus) are one of the most successful and harmful invasive predator species, leading to dramatic loss of biodiversity across the globe. Our study assessed feral cat predation in a major biodiversity hotspot: the New Caledonian archipelago. We focused on the consequences of this predation for the outstanding endemic fauna found throughout the rich range of New Caledonian natural habitats. We analyzed > 5300 cat scats sampled from 14 selected sites representing the 4 main natural habitats, with 4 to 6 sampling sessions per year over > 4 years per habitat. Our study reveals previously unreported patterns of cat predation on both alien and endemic species. Throughout the archipelago, cats prey strongly upon squamates, flying foxes and petrels. Feral cat prey included at least 44 native vertebrate species, 20 of which are IUCN Red-listed threatened species. This study adds some 44.4% to the number of IUCN threatened species vulnerable to and preyed upon by feral cats on the world's islands. New Caledonia, while it represents only 0.12% of the total area of islands worldwide (Australia included), hosts 30.8% of IUCN threatened species known to be predated by feral cats. This study recommends prioritizing management and conservation strategies by focusing actions on maquis mosaic and humid forest habitats, where feral cats pose the greatest threat. To limit the impact of feral cats, we recommend conducting targeted management actions on sites key to threatened species conservation, and preventing arrival or promoting eradication on islets.
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