BACKGROUND: The clinical application of voice technology provides novel opportunities in the field of telehealth. However, patients' readiness for this solution has not been investigated among patients with cardiovascular diseases (CVD). OBJECTIVE: This paper aims to evaluate patients' anticipated experiences regarding telemedicine, including voice conversational agents combined with provider-driven support delivered by phone. METHODS: A cross-sectional study enrolled patients with chronic CVD who were surveyed using a validated investigator-designed questionnaire combining 19 questions (eg, demographic data, medical history, preferences for using telehealth services). Prior to the survey, respondents were educated on the telemedicine services presented in the questionnaire while being assisted by a medical doctor. Responses were then collected and analyzed, and multivariate logistic regression was used to identify predictors of willingness to use voice technology. RESULTS: In total, 249 patients (mean age 65.3, SD 13.8 years; 158 [63.5%] men) completed the questionnaire, which showed good repeatability in the validation procedure. Of the 249 total participants, 209 (83.9%) reported high readiness to receive services allowing for remote contact with a cardiologist (176/249, 70.7%) and telemonitoring of vital signs (168/249, 67.5%). The voice conversational agents combined with provider-driven support delivered by phone were shown to be highly anticipated by patients with CVD. The readiness to use telehealth was statistically higher in people with previous difficulties accessing health care (OR 2.920, 95% CI 1.377-6.192) and was most frequent in city residents and individuals reporting a higher education level. The age and sex of the respondents did not impact the intention to use voice technology (P=.20 and P=.50, respectively). CONCLUSIONS: Patients with cardiovascular diseases, including both younger and older individuals, declared high readiness for voice technology.

Department of Cardiology and Structural Heart Diseases Medical University of Silesia Katowice Poland

Department of Epidemiology Faculty of Medical Sciences in Katowice Medical University of Silesia Katowice Poland

Interventional Cardiac Electrophysiology Group International Clinical Research Center St Anne's University Hospital Brno Brno Czech Republic

Research and Development Division CardioCube Corp Seattle WA United States

Student Scientific Society Department of Epidemiology Faculty of Medical Sciences in Katowice Medical University of Silesia Katowice Poland

Zobrazit více v PubMed

Di Lenarda A, Casolo G, Gulizia M, Aspromonte N, Scalvini S, Mortara A, Alunni G, Ricci RP, Mantovan R, Russo G, Gensini GF, Romeo F. The future of telemedicine for the management of heart failure patients: a Consensus Document of the Italian Association of Hospital Cardiologists (A.N.M.C.O), the Italian Society of Cardiology (S.I.C.) and the Italian Society for Telemedicine and eHealth (Digital S.I.T.) Eur Heart J Suppl. 2017 May;19(Suppl D):D113–D129. doi: 10.1093/eurheartj/sux024. PubMed DOI PMC

Sim I. Mobile Devices and Health. N Engl J Med. 2019 Sep 05;381(10):956–968. doi: 10.1056/nejmra1806949. PubMed DOI

Jadczyk T, Kiwic O, Khandwalla RM, Grabowski K, Rudawski S, Magaczewski P, Benyahia H, Wojakowski W, Henry TD. Feasibility of a voice-enabled automated platform for medical data collection: CardioCube. Int J Med Inform. 2019 Sep;129:388–393. doi: 10.1016/j.ijmedinf.2019.07.001. PubMed DOI

Piotrowicz R, Krzesiński P, Balsam P, Kempa M, Główczyńska R, Grabowski M, Kołtowski Ł, Lewicka E, Peller M, Piotrowicz E, Podolec J, Stańczyk A, Zajdel J, Opolski G. [Cardiology telemedicine solutions - opinion of the experts of the Committee of Informatics and Telemedicine of Polish Society of Cardiology, Section of Non-invasive Electrocardiology and Telemedicine of Polish Society of Cardiology and Clinical Sciences C] Kardiol Pol. 2018;76(3):698–707. doi: 10.5603/KP.a2018.0058. doi: 10.5603/KP.a2018.0058. PubMed DOI

Schwamm LH, Chumbler N, Brown E, Fonarow GC, Berube D, Nystrom K, Suter R, Zavala M, Polsky D, Radhakrishnan K, Lacktman N, Horton K, Malcarney M, Halamka J, Tiner AC. Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association. Circulation. 2017 Feb 14;135(7):e24–e44. doi: 10.1161/cir.0000000000000475. PubMed DOI

Ponikowski P, Voors A, Anker S, Bueno H, Cleland J, Coats A, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 Jul 14;37(27):2129–2200. doi: 10.1093/eurheartj/ehw128. PubMed DOI

Zhu Y, Gu X, Xu C. Effectiveness of telemedicine systems for adults with heart failure: a meta-analysis of randomized controlled trials. Heart Fail Rev. 2020 Mar 24;25(2):231–243. doi: 10.1007/s10741-019-09801-5. PubMed DOI PMC

Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JGF. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev. 2015;10:CD007228. doi: 10.1002/14651858.CD007228.pub3. PubMed DOI PMC

Lorenz A, Oppermann R. Mobile health monitoring for the elderly: Designing for diversity. Pervasive Mobile Comput. 2009 Oct;5(5):478–495. doi: 10.1016/j.pmcj.2008.09.010. doi: 10.1016/j.pmcj.2008.09.010. DOI

Prescher S, Deckwart O, Winkler S, Koehler K, Honold M, Koehler F. Telemedical care: feasibility and perception of the patients and physicians: a survey-based acceptance analysis of the Telemedical Interventional Monitoring in Heart Failure (TIM-HF) trial. Eur J Prev Cardiol. 2013 Jun;20(2 Suppl):18–24. doi: 10.1177/2047487313487483e. PubMed DOI

Sezgin E, Noritz G, Elek A, Conkol K, Rust S, Bailey M, Strouse R, Chandawarkar A, von Sadovszky V, Lin S, Huang Y. Capturing At-Home Health and Care Information for Children With Medical Complexity Using Voice Interactive Technologies: Multi-Stakeholder Viewpoint. J Med Internet Res. 2020 Feb 13;22(2):e14202. doi: 10.2196/14202. PubMed DOI PMC

Furst J. Mayo Clinic introduces skill for Amazon's Alexa about COVID-19. Mayo Clinic. 2020. Apr 27, [2020-07-22]. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-introduces-skill-for-amazons-alexa-about-covid-19/

CardioCube. FCNcare. [2020-07-22]. https://fcncare.com/

Kowalska M, Baranski K. Biostatistics. Practical methods for assessing the reliability of questionnaire surveys. Katowice, Poland: The Medical University of Silesia in Katowice; 2017.

Benjamin E, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind Ms, Ferguson Jf, Fornage M, Jordan Lc, Khan Ss, Kissela Bm, Knutson Kl, Kwan Tw, Lackland Dt, Lewis Tt, Lichtman Jh, Longenecker Ct, Loop Ms, Lutsey Pl, Martin Ss, Matsushita K, Moran Ae, Mussolino Me, O’Flaherty M, Pandey A, Perak Am, Rosamond Wd, Roth Ga, Sampson Uk, Satou Gm, Schroeder Eb, Shah Sh, Spartano Nl, Stokes A, Tirschwell Dl, Tsao Cw, Turakhia Mp, VanWagner Lb, Wilkins Jt, Wong Ss, Virani Ss. Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association. Circulation. 2019 Mar 05;139(10):e56–e528. doi: 10.1161/cir.0000000000000659. PubMed DOI

Pinaire J, Azé J, Bringay S, Cayla G, Landais P. Hospital burden of coronary artery disease: Trends of myocardial infarction and/or percutaneous coronary interventions in France 2009-2014. PLoS One. 2019;14(5):e0215649. doi: 10.1371/journal.pone.0215649. PubMed DOI PMC

Jackson SL, Tong X, King RJ, Loustalot F, Hong Y, Ritchey MD. National Burden of Heart Failure Events in the United States, 2006 to 2014. Circ Heart Failure. 2018 Dec;11(12):e004873. doi: 10.1161/circheartfailure.117.004873. PubMed DOI PMC

Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer. J Med Internet Res. 2017 May 17;19(5):e172. doi: 10.2196/jmir.6688. PubMed DOI PMC

Lorig KR, Ritter PL, Laurent DD, Plant K. Internet-based chronic disease self-management: a randomized trial. Med Care. 2006 Nov;44(11):964–71. doi: 10.1097/01.mlr.0000233678.80203.c1. PubMed DOI

Kim JY, Wineinger NE, Steinhubl SR. The Influence of Wireless Self-Monitoring Program on the Relationship Between Patient Activation and Health Behaviors, Medication Adherence, and Blood Pressure Levels in Hypertensive Patients: A Substudy of a Randomized Controlled Trial. J Med Internet Res. 2016 Jun 22;18(6):e116. doi: 10.2196/jmir.5429. PubMed DOI PMC

Quilici J, Fugon L, Beguin S, Morange PE, Bonnet J, Alessi M, Carrieri P, Cuisset T. Effect of motivational mobile phone short message service on aspirin adherence after coronary stenting for acute coronary syndrome. Int J Cardiol. 2013 Sep 20;168(1):568–9. doi: 10.1016/j.ijcard.2013.01.252. PubMed DOI

Khonsari S, Subramanian P, Chinna K, Latif LA, Ling LW, Gholami O. Effect of a reminder system using an automated short message service on medication adherence following acute coronary syndrome. Eur J Cardiovasc Nurs. 2015 Apr;14(2):170–9. doi: 10.1177/1474515114521910. PubMed DOI

Blasco A, Carmona M, Fernández-Lozano I, Salvador CH, Pascual M, Sagredo PG, Somolinos R, Muñoz A, García-López F, Escudier JM, Mingo S, Toquero J, Moñivas V, González MA, Fragua JA, López-Rodríguez F, Monteagudo JL, Alonso-Pulpón L. Evaluation of a Telemedicine Service for the Secondary Prevention of Coronary Artery Disease. J Cardiopulmonary Rehabil Prev. 2012;32(1):25–31. doi: 10.1097/hcr.0b013e3182343aa7. PubMed DOI

Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev. 2013 Dec 05;12:CD007458. doi: 10.1002/14651858.CD007458.pub3. PubMed DOI PMC

Marti P, Iacono I. Anticipated, momentary, episodic, remembered: the many facets of User eXperience. Federated Conference on Computer Science and Information Systems (FedCSIS); Sep 11-14, 2016; Gdansk, Poland. 2016. pp. 11–14. DOI

Abdekhoda M, Ahmadi M, Dehnad A, Hosseini AF. Information Technology Acceptance in Health Information Management. Methods Inf Med. 2018 Jan 20;53(01):14–20. doi: 10.3414/me13-01-0079. PubMed DOI

Edwards L, Thomas C, Gregory A, Yardley L, O'Cathain A, Montgomery AA, Salisbury C. Are people with chronic diseases interested in using telehealth? A cross-sectional postal survey. J Med Internet Res. 2014 May;16(5):e123. doi: 10.2196/jmir.3257. PubMed DOI PMC

Safi S, Danzer G, Schmailzl KJ. Empirical Research on Acceptance of Digital Technologies in Medicine Among Patients and Healthy Users: Questionnaire Study. JMIR Hum Factors. 2019 Nov 29;6(4):e13472. doi: 10.2196/13472. PubMed DOI PMC

Harst L, Lantzsch H, Scheibe M. Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review. J Med Internet Res. 2019 May 21;21(5):e13117. doi: 10.2196/13117. PubMed DOI PMC

Or CKL, Karsh B. A systematic review of patient acceptance of consumer health information technology. J Am Med Inform Assoc. 2009;16(4):550–60. doi: 10.1197/jamia.M2888. PubMed DOI PMC

Zhao Y, Ni Q, Zhou R. What factors influence the mobile health service adoption? A meta-analysis and the moderating role of age. Int J Inform Manage. 2018 Dec;43:342–350. doi: 10.1016/j.ijinfomgt.2017.08.006. doi: 10.1016/j.ijinfomgt.2017.08.006. DOI

Kinsella B. Nearly 90 Million U.S. Adults Have Smart Speakers, Adoption Now Exceeds One-Third of Consumers. Voicebot. [2020-05-15]. https://voicebot.ai/2020/04/28/nearly-90-million-u-s-adults-have-smart-speakers-adoption-now-exceeds-one-third-of-consumers/

Lin Y, Huang G, Ho Y, Lou M. Patient willingness to undergo a two-week free trial of a telemedicine service for coronary artery disease after coronary intervention: A mixed-methods study. J Nurs Manag. 2020 Mar;28(2):407–416. doi: 10.1111/jonm.12942. PubMed DOI

Jiang J, Zhu Q, Zheng Y, Zhu Y, Li Y, Huo Y. Perceptions and Acceptance of mHealth in Patients With Cardiovascular Diseases: A Cross-Sectional Study. JMIR Mhealth Uhealth. 2019 Feb 04;7(2):e10117. doi: 10.2196/10117. PubMed DOI PMC

Lee J, Nguyen AL, Berg J, Amin A, Bachman M, Guo Y, Evangelista L. Attitudes and preferences on the use of mobile health technology and health games for self-management: interviews with older adults on anticoagulation therapy. JMIR Mhealth Uhealth. 2014 Jul 23;2(3):e32. doi: 10.2196/mhealth.3196. PubMed DOI PMC

Illiger K, Hupka M, von Jan U, Wichelhaus D, Albrecht U. Mobile technologies: expectancy, usage, and acceptance of clinical staff and patients at a university medical center. JMIR Mhealth Uhealth. 2014 Oct 21;2(4):e42. doi: 10.2196/mhealth.3799. PubMed DOI PMC

van Houwelingen CT, Ettema RG, Antonietti MG, Kort HS. Understanding Older People's Readiness for Receiving Telehealth: Mixed-Method Study. J Med Internet Res. 2018 Apr 06;20(4):e123. doi: 10.2196/jmir.8407. PubMed DOI PMC

Muigg D, Duftschmid G, Kastner P, Modre-Osprian R, Haluza D. Telemonitoring readiness among Austrian diabetic patients: A cross-sectional validation study. Health Informatics J. 2020 Feb 12;:E. doi: 10.1177/1460458219894094. PubMed DOI

Readiness for Telemedical Services in Patients With Cardiovascular Diseases: Cross-sectional Study

Artificial Intelligence Can Improve Patient Management at the Time of a Pandemic: The Role of Voice Technology