PURPOSE OF REVIEW: A critical evaluation of contemporary literature regarding the role of big data, artificial intelligence, and digital technologies in precision cardio-oncology care and survivorship, emphasizing innovative and groundbreaking endeavors. RECENT FINDINGS: Artificial intelligence (AI) algorithm models can automate the risk assessment process and augment current subjective clinical decision tools. AI, particularly machine learning (ML), can identify medically significant patterns in large data sets. Machine learning in cardio-oncology care has great potential in screening, diagnosis, monitoring, and managing cancer therapy-related cardiovascular complications. To this end, large-scale imaging data and clinical information are being leveraged in training efficient AI algorithms that may lead to effective clinical tools for caring for this vulnerable population. Telemedicine may benefit cardio-oncology patients by enhancing healthcare delivery through lowering costs, improving quality, and personalizing care. Similarly, the utilization of wearable biosensors and mobile health technology for remote monitoring holds the potential to improve cardio-oncology outcomes through early intervention and deeper clinical insight. Investigations are ongoing regarding the application of digital health tools such as telemedicine and remote monitoring devices in enhancing the functional status and recovery of cancer patients, particularly those with limited access to centralized services, by increasing physical activity levels and providing access to rehabilitation services. SUMMARY: In recent years, advances in cancer survival have increased the prevalence of patients experiencing cancer therapy-related cardiovascular complications. Traditional cardio-oncology risk categorization largely relies on basic clinical features and physician assessment, necessitating advancements in machine learning to create objective prediction models using diverse data sources. Healthcare disparities may be perpetuated through AI algorithms in digital health technologies. In turn, this may have a detrimental effect on minority populations by limiting resource allocation. Several AI-powered innovative health tools could be leveraged to bridge the digital divide and improve access to equitable care.
- Publication type
- Journal Article MeSH
BACKGROUND: To predict worsening heart failure hospitalizations (WHFHs), the HeartInsight multiparametric algorithm calculates a heart failure (HF) Score based on temporal trends of physiologic parameters obtained through automatic daily remote monitoring of implantable cardioverter-defibrillators (ICDs). OBJECTIVE: We studied the association of the baseline HF Score, determined at algorithm activation, with long-term patient outcomes. METHODS: Data from 9 clinical trials were pooled, including 1841 ICD patients with a preimplantation ejection fraction ≤35%, New York Heart Association class II/III, and no long-standing atrial fibrillation. The primary end point was a composite of death or WHFH. RESULTS: After a median follow-up of 631 days (interquartile range, 385-865 days), there were 243 WHFHs in 173 patients (9.4%) and 122 deaths (6.6%), 52 of which (42.6%) were cardiovascular. The primary end point occurred in 265 patients (14.4%). A multivariable time-to-first-event analysis showed that a high baseline HF Score (>23, as determined by a time-dependent receiver operating characteristics curve analysis) was significantly associated with the occurrence of the primary end point (adjusted hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.54-2.71; P < .0001), all-cause death (HR, 2.37; CI, 1.56-3.58; P < .0001), cardiovascular death (HR, 2.19; CI, 1.14-4.22; P = .019), and WHFH (HR, 1.91; CI, 1.35-2.71; P = .0003). In a hierarchical event analysis of all-cause death as the outcome with highest priority and WHFHs as repeated event outcomes, the win ratio was 2.47 (CI, 1.89-3.24; P < .0001). CONCLUSION: Based on a retrospective analysis of clinical trial data with adjudicated events, baseline HF Score derived from device-monitored variables was able to stratify patients at higher long-term risk of death or WHFH.
- MeSH
- Algorithms MeSH
- Time Factors MeSH
- Defibrillators, Implantable * MeSH
- Clinical Trials as Topic MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Aged MeSH
- Heart Failure * therapy physiopathology mortality MeSH
- Remote Sensing Technology methods MeSH
- Stroke Volume physiology MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Úvod: Mnohé štúdie a metaanalýzy preukázali, že telemonitorovanie krvného tlaku ako aj iných faktorov metabolického syndrómu môže zlepšiť ich manažment. Avšak mnoho pacientov nevyužíva telemonitorovanie kvôli osobným, technologickým a iným bariéram. Cieľom tejto štúdie bolo zistenie aké sú perspektívy a prekážky telemonitoringu lipitenzie na Slovensku z pohľadu pacienta. Metódy: Táto štúdia bola realizovaná ako dotazníková a mala za cieľ osloviť 2 545 pacientov. Dotazník pozostával z častí zameraných na osobné charakteristiky pacienta, návyky z hľadiska merania krvného tlaku (TK), na využívanie smart-technológií, ich predpokladané prínosy a prekážky z hľadiska pacienta ako aj na znalosť lipidového profilu a kardiovaskulárneho rizika samotným pacientom. Výsledky: Celkovo sme získali 252 odpovedí od pacientov (9,9 %). Z celkového počtu opýtaných má arteriálnu hypertenziu 67,4 %, kým nefarmakologickú terapiu užíva 7,9 %. Denne si TK meria len 21,2 % hypertonikov, signifikantne vyšší počet mužov ako žien (p = 0,011) a najčastejšie si meria TK veková kategória 31–45 rokov. Až 19,4 % využíva nositeľné zariadenia a 6,3 % tlakomery prepojené s aplikáciou. Signifikantne častejšie smart-technológie využíva kategória 31–45-ročných (p = 0,01). Závažné prekážky využitia smart-technológií neboli identifikované, väčšina si vyžadovala funkciu vzdialených konzultácií, úpravy liekov a jednoduché užívateľské rozhranie. Väčšina pacientov nevie svoju hodnotu LDL-cholesterolu a až 45,7 % tých čo vie, malo zvýšené hladiny. Záver: Celkovo prevláda záujem o využitie metód telemedicíny krvného tlaku, pri jej implementácii na Slovensku bude však nutná spolupráca pacienta a lekára.
Introduction: Numerous studies and meta-analyses have demonstrated that telemonitoring of blood pressure and other factors of metabolic syndrome can improve their management. However, many patients do not use telemonitoring due to personal, technological, and healthcare barriers. The aim of this study was to identify the perspectives and barriers to telemonitoring of lipid levels in Slovakia from the patient’s point of view. Methods: This study was conducted as a questionnaire-based survey targeting 2,545 patients. The questionnaire consisted of sections focused on patients’ personal characteristics, habits regarding blood pressure measurement, the use of smart technologies, their perceived benefits and barriers, as well as the patients’ knowledge of their lipid profile and cardiovascular risk. Results: A total of 252 responses were obtained (9.9 % response rate). Among the respondents, 67.4 % had hypertension, while 7.9 % were on non-pharmacological therapy. Only 21.2 % of hypertensive patients measured their blood pressure daily, with a significantly higher proportion of men compared to women (p = 0.011), and the most frequent blood pressure monitoring was observed in the 31–45 age group. A total of 19.4 % used wearable devices, and 6.3 % used blood pressure monitors connected to an app. Smart technology use was significantly more common in the 31–45 age group (p = 0.01). No severe barriers to the use of smart technologies were identified; most patients required features such as remote consultations, medication adjustments, and user-friendly interfaces. The majority of patients were unaware of their LDL-C values, and 45.7 % of those who were aware had elevated levels. Conclusion: There is a prevailing interest in implementing telemedicine methods for blood pressure monitoring. However, collaboration between patients and physicians will be necessary for its successful implementation in Slovakia.
- MeSH
- Digital Health MeSH
- Dyslipidemias prevention & control MeSH
- Hypertension * epidemiology prevention & control MeSH
- Humans MeSH
- Blood Pressure Determination methods MeSH
- Surveys and Questionnaires MeSH
- Heart Disease Risk Factors MeSH
- Statistics as Topic MeSH
- Telemedicine * methods MeSH
- Check Tag
- Humans MeSH
- Geographicals
- Slovakia MeSH
V súčasnosti, aj napriek významnému pokroku v terapii akútnych kardiovaskulárnych (KV) príhod, miera kontroly krvného tlaku a dyslipidémií, ako hlavných rizikových faktorov KV-ochorení (KVO), stagnuje a tradičné prístupy často zlyhávajú. Iniciatívy v oblasti digitálnej medicíny sa začali objavovať už predtým, ako pandémia COVID-19 zásadne ovplyvnila spôsob poskytovania zdravotnej starostlivosti. Artériová hypertenzia je ideálnym kandidátom na vzdialený manažment a digitálne riešenia v tejto oblasti rýchlo pribúdajú. Štúdie preukázali, že metódy telemedicíny signifikantne znižujú systolický, ako aj diastolický tlak pacientov a pomáhajú zlepšovať dosahovanie cieľových hodnôt tlaku a adherenciu k terapii. Bolo však taktiež preukázané, že metódy mHealth (mobile Health) museli byť spojené so súbežnou konzultáciou so zdravotníkom. Aplikácie na monitorovanie vlastného zdravia, prípadne ,,selfcouching‘‘, ktoré fungovali na pasívnom zbere dát, nepreukázali vyššie uvedené výsledky. Taktiež sa ukázalo, že existujú mnohé prekážky v implementácii týchto technológií, ako sú prístrojové (používanie validovaných tlakomerov a metód merania), finančné (úhrady zo zdravotného poistenia, náklady pre pacienta), legislatívne (hlavne ochrana osobných údajov) a taktiež neexistujúca štandardizácia v tejto oblasti. Metódy telemedicíny sa začali uplatňovať aj pri manažmente dyslipidémií, lebo sa zistilo, že vzdialený manažment pacienta so súbežným informovaním samotného pacienta o jeho KV-riziku môže výrazne dopomôcť k zlepšeniu adherencie k terapii a v dosahovaní cieľových hodnôt lipidových parametrov.
Currently, despite significant advances in the treatment of acute cardiovascular (CV) events, rates of blood pressure control and dyslipidemia, as major risk factors for CV disease (CVD), are stagnant and traditional approaches often fail. Initiatives in digital medicine have already started to emerge before the COVID-19 pandemic fundamentally impacted the way healthcare is delivered. Arterial hypertension is an ideal candidate for remote management, and digital solutions in this area are rapidly gaining traction. Studies have shown that telemedicine methods significantly reduce both systolic and diastolic blood pressure of patients and help improve achievement of target blood pressure values and adherence to therapy. However, it was also shown that mHealth (mobile Health) methods had to be associated with concurrent consultation with a healthcare professional. Self-monitoring or “selfcouching” apps that worked on passive data collection did not show the above results. It has also been shown that there are many barriers to the implementation of these technologies, such as instrumentation (use of validated blood pressure monitors and measurement methods), financial (health insurance reimbursement, cost to the patient), legislative (mainly privacy) and also the lack of standardization in this area. Telemedicine methods have also started to be applied in the management of dyslipidemia, where it has been found that remote patient management with simultaneous information to the patient about his/her CV risk can significantly help to improve adherence to therapy and in achieving target values of lipid parameters.
Carbonaceous aerosols (CA), composed of black carbon (BC) and organic matter (OM), significantly impact the climate. Light absorption properties of CA, particularly of BC and brown carbon (BrC), are crucial due to their contribution to global and regional warming. We present the absorption properties of BC (bAbs,BC) and BrC (bAbs,BrC) inferred using Aethalometer data from 44 European sites covering different environments (traffic (TR), urban (UB), suburban (SUB), regional background (RB) and mountain (M)). Absorption coefficients showed a clear relationship with station setting decreasing as follows: TR > UB > SUB > RB > M, with exceptions. The contribution of bAbs,BrC to total absorption (bAbs), i.e. %AbsBrC, was lower at traffic sites (11-20 %), exceeding 30 % at some SUB and RB sites. Low AAE values were observed at TR sites, due to the dominance of internal combustion emissions, and at some remote RB/M sites, likely due to the lack of proximity to BrC sources, insufficient secondary processes generating BrC or the effect of photobleaching during transport. Higher bAbs and AAE were observed in Central/Eastern Europe compared to Western/Northern Europe, due to higher coal and biomass burning emissions in the east. Seasonal analysis showed increased bAbs, bAbs,BC, bAbs,BrC in winter, with stronger %AbsBrC, leading to higher AAE. Diel cycles of bAbs,BC peaked during morning and evening rush hours, whereas bAbs,BrC, %AbsBrC, AAE, and AAEBrC peaked at night when emissions from household activities accumulated. Decade-long trends analyses demonstrated a decrease in bAbs, due to reduction of BC emissions, while bAbs,BrC and AAE increased, suggesting a shift in CA composition, with a relative increase in BrC over BC. This study provides a unique dataset to assess the BrC effects on climate and confirms that BrC can contribute significantly to UV-VIS radiation presenting highly variable absorption properties in Europe.
- MeSH
- Aerosols * analysis MeSH
- Air Pollutants analysis MeSH
- Environmental Monitoring MeSH
- Particulate Matter analysis MeSH
- Light MeSH
- Carbon * analysis MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
Well-being and social interaction are among the primary goals to be achieved for the elderly. Intergenerational physical activity (PA) has gained increasing attention due to its potential to encourage PA and social interaction, providing both social and physical benefits to both younger and older individuals. This review aimed to gain a deeper understanding of the potential roles of PA in facilitating intergenerational interactions and provide practical insights. Methods: Following PRISMA guidelines, the systematic review identified specific keywords to search for articles that met the chosen inclusion and exclusion criteria (n. 5 RCT articles, selected between 2009 and 2024), conducted by three independent reviewers. Scopus, PubMed, EBSCOhost, and Web of Science were consulted to identify relevant articles. Risk of bias was assessed using Cochrane RoB 2. For the narrative dissertation, articles were identified across three key areas of focus: types of PA, age groups, and intended goals. Results: Few studies have specifically implemented PA protocols in intergenerational relationships, and most have planned remote activities without monitoring outcomes. The main advantages of intergenerational PA are oriented towards the social and relational sphere rather than simple PA involvement. Conclusions: For the elderly, these programs may help mitigate age-related deficits, while children and adolescents, when adapting to their older counterparts, experience greater effectiveness when provided with clear guidance during shared activities. Considering the characteristics and needs of individuals of different ages, different activities must be proposed to obtain different results. The organization of workshops and preparatory sessions will help in facilitating relationships and interactions among participants.
- Publication type
- Journal Article MeSH
- Review MeSH
The ultimate goal of value-based laboratory medicine is maximizing the effectiveness of laboratory tests in improving patient outcomes, optimizing resources and minimizing unnecessary costs. This approach abandons the oversimplified notion of test volume and cost, in favor of emphasizing the clinical utility and quality of diagnostic tests in the clinical decision-making. Several key elements characterize value-based laboratory medicine, which can be summarized in some basic concepts, such as organization of in vitro diagnostics (including appropriateness, integrated diagnostics, networking, remote patient monitoring, disruptive innovations), translation of laboratory data into clinical information and measurable outcomes, sustainability, reimbursement, ethics (e.g., patient empowerment and safety, data protection, analysis of big data, scientific publishing). Education and training are also crucial, along with considerations for the future of the profession, which will be largely influenced by advances in automation, information technology, artificial intelligence, and regulations concerning in vitro diagnostics. This collective opinion paper, composed of summaries from presentations given at the two-day European Federation of Laboratory Medicine (EFLM) Strategic Conference "A vision to the future: value-based laboratory medicine" (Padova, Italy; September 23-24, 2024), aims to provide a comprehensive overview of value-based laboratory medicine, projecting the profession into a more clinically effective and sustainable future.
- MeSH
- Laboratories, Clinical * economics trends MeSH
- Clinical Laboratory Techniques economics trends MeSH
- Congresses as Topic MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Participation in cardio-oncological rehabilitation is low, and the effects incline to decrease after the initial rehabilitation term. Home-based exercise has the potential to enhance involvement in cardio-oncology rehabilitation and was demonstrated to be feasible, safe, and helpful in increasing short-term cardiorespiratory fitness. The lasting effects on cardiorespiratory fitness and physical activity are uncertain. Hence, a novel approach via telehealth management based on objectively measured exercise at home was proposed. OBJECTIVES: To improve self-monitoring, such as self-confidence, behavioral change, and goal setting for individual exercise, and afterward, increase long-term effects concerning cardiorespiratory fitness. DESIGN: This randomized controlled trial compares a 12-week guided home exercise telehealth intervention with a center-based exercise intervention of the same duration and intensity of exercise in lymphoma cancer survivors entering cardio-oncology rehabilitation after treatment. Participants will be instructed to exercise gradually at 60-85% of their maximum heart rate for 30-50 min 3 times a week. Participants will receive individual remote guidance (feedback about frequency, duration, and exercise intensity) by preferred contact (phone call, text message) once a week based on shared exercise data through the web platform. The primary outcome is a change in cardiorespiratory fitness expressed as maximal oxygen uptake assessed through cardiopulmonary exercise test at baseline, 12 weeks, and 1 year. Secondary objectives are quality of life, muscle strength, body composition, incidence of adverse events, and exercise adherence. This study will determine whether a telehealth model is effective and safe compared to a center-based model in cancer survivors and whether exercise prescriptions are followed by participants. Additionally, an overview of the long-term effectiveness of telehealth cardio-oncology rehabilitation will be provided. This approach aligns with the trend of moving non-complex healthcare services into the patients' home environment. TRIAL REGISTRATION: ClinicalTrials.Gov Identifier: NCT05779605.
- Publication type
- Journal Article MeSH
AIMS: A pulsed electric field (PF) energy source is a novel potential option for catheter ablation of ventricular arrhythmias (VAs) as it can create deeper lesions, particularly in scarred tissue. However, very limited data exist on its efficacy and safety. This prospective observational study reports the initial experience with VA ablation using focal PF. METHODS AND RESULTS: The study population consisted of 44 patients (16 women, aged 61 ± 14years) with either frequent ventricular premature complexes (VPCs, 48%) or scar-related ventricular tachycardia (VT, 52%). Ablation was performed using an irrigated 4 mm tip catheter and a commercially available PF generator. On average, 16 ± 15 PF applications (25 A) were delivered per patient. Acute success was achieved in 84% of patients as assessed by elimination of VPC or reaching non-inducibility of VT. In three cases (7%), a transient conduction system block was observed during PF applications remotely from the septum. Root analysis revealed that this event was caused by current leakage from the proximal shaft electrodes in contact with the basal interventricular septum. Acute elimination of VPC was achieved in 81% patients and non-inducibility of VT in 83% patients. At the 3-month follow-up, persistent suppression of the VPC was confirmed on Holter monitoring in 81% patients. In the VT group, the mean follow-up was 116 ± 75 days and a total of 52% patients remained free of any VA. CONCLUSION: Pulsed electric field catheter ablation of a broad spectrum of VA is feasible with acute high efficacy; however, the short-term follow-up is less satisfactory for patients with scar-related VT.
- MeSH
- Electrophysiologic Techniques, Cardiac MeSH
- Cicatrix etiology MeSH
- Catheter Ablation * methods adverse effects MeSH
- Tachycardia, Ventricular * surgery physiopathology MeSH
- Ventricular Premature Complexes * surgery physiopathology diagnosis MeSH
- Middle Aged MeSH
- Humans MeSH
- Prospective Studies MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
Telemedicine is an emerging development in the healthcare domain, where the Internet of Things (IoT) fiber optics technology assists telemedicine applications to improve overall digital healthcare performances for society. Telemedicine applications are bowel disease monitoring based on fiber optics laser endoscopy, gastrointestinal disease fiber optics lights, remote doctor-patient communication, and remote surgeries. However, many existing systems are not effective and their approaches based on deep reinforcement learning have not obtained optimal results. This paper presents the fiber optics IoT healthcare system based on deep reinforcement learning combinatorial constraint scheduling for hybrid telemedicine applications. In the proposed system, we propose the adaptive security deep q-learning network (ASDQN) algorithm methodology to execute all telemedicine applications under their given quality of services (deadline, latency, security, and resources) constraints. For the problem solution, we have exploited different fiber optics endoscopy datasets with images, video, and numeric data for telemedicine applications. The objective is to minimize the overall latency of telemedicine applications (e.g., local, communication, and edge nodes) and maximize the overall rewards during offloading and scheduling on different nodes. The simulation results show that ASDQN outperforms all telemedicine applications with their QoS and objectives compared to existing state action reward state (SARSA) and deep q-learning network (DQN) policy during execution and scheduling on different nodes.
- MeSH
- Algorithms MeSH
- Deep Learning * MeSH
- Internet of Things * MeSH
- Humans MeSH
- Fiber Optic Technology MeSH
- Telemedicine * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
