BackgroundAtrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study.ObjectiveThe objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm.MethodsWe conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire.ResultsBetween March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4%, 22/922) residents with AF were identified by the physician’s ECG interpretation, and only 0.2% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5% (95% CI 77.2%-99.9%) and specificity of 97.7% (95% CI 96.5%-98.5%). The overall satisfaction score for the process of AF screening was 92.1%.ConclusionsAF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible.
Background Hypertension is associated with a large global disease burden with variable control rates across different regions and races. Telehealth has recently emerged as a health care strategy for managing chronic diseases, but there are few reports regarding the effects of synchronous telehealth services on home blood pressure (BP) control and variability. Objective The objective of this study is to investigate the effect of synchronous telehealth services with a digital platform on home BP. Methods This retrospective study was conducted by the Taiwan ELEctroHEALTH study group at the Telehealth Center of the National Taiwan University Hospital. We analyzed home BP data taken from 2888 patients with cardiovascular disease (CVD) enrolled in our telehealth program between 2009 to 2017. Of the 2888 patients with CVD, 348 (12.05%) patients who received home BP surveillance for ≥56 days were selected for BP analysis. Patients were stratified into three groups: (1) poorly controlled hypertension, (2) well-controlled hypertension, and (3) nonhypertension. The mean, SD, coefficient of variation (CV), and average real variability were calculated. Results Telehealth interventions significantly and steadily reduced systolic blood pressure (SBP) in the poorly controlled hypertension group from 144.8.2±9.2 to 133.7±10.2 mmHg after 2 months (P<.001). BP variability reduced in all patients: SBP-SD decreased from 7.8±3.4 to 7.3±3.4 after 2 months (P=.004), and SBP-CV decreased from 6.3±2.5 to 5.9±2.6 after 2 months (P=.004). Event-free survival (admission) analysis stratified by SBP-SD showed longer time to first hospitalization for Q1 patients compared with Q4 patients (P=.02, odds ratio 2.15, 95% CI 1.18-3.89). Conclusions Synchronous telehealth intervention may improve home BP control and decrease day-by-day home BP variability in patients with CVD.
BACKGROUND Hypertension is associated with a large global disease burden with variable controlled rate across different regions and races. Telehealth has recently emerged as a healthcare strategy for managing chronic diseases, but there have been few reports regarding the effects of synchronous telehealth services on home blood pressure (BP) control and variability. OBJECTIVE This study aimed to investigate the effect of fourth-generation synchronous telehealth services on home blood pressure. METHODS This retrospective study was conducted by the TELEHEALTH study group at the Telehealth Center in National Taiwan University Hospital. We analyzed home BP data taken from 2,888 cardiovascular disease patients who were enrolled in our telehealth program and received telehealth services between 2009 and 2017. Mean, standard deviation (SD), coefficient variability (CV), and average real variability (ARV) were calculated. RESULTS A total of 398 patients who underwent constant home BP surveillance for ≥ 2 months were recruited for this study. Patients were stratified into three groups: (1) Poorly-controlled hypertension, (2) Well-controlled hypertension, and (3) Non-hypertension. Telehealth significantly reduced systolic BP in the poorly-controlled hypertension group from 145.2±9.3 mmHg to 132.8±10.3 mmHg after 2 months (P<.001). BP variability was reduced in all patients: SBP-SD decreased from 7.7±3.4 to 7.1±3.2 after 2 months (P<.001), and SBP-CV decreased from 6.2±2.5 to 5.7±2.4 after 2 months (P<.001). Event free survival (admission) analysis stratified by SBP-SD showed longer time to first hospitalization for Q1 patients compared with Q4 patients (P=.04). CONCLUSIONS Synchronous telehealth intervention may improve home BP control and decrease day-by-day home BP variability in patients with cardiovascular disease.
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