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Patient Use of Cardiovascular Devices and Apps: Are We Getting Our Money's Worth?
Aguillard, K, Garson, A
Methodist DeBakey cardiovascular journal. 2020;(4):291-295
Abstract
The evolution of technology makes it likely that a large number of people will invest in and use health-related mobile applications and wearable devices. Yet the question remains: Do these technology-based interventions modify health behavior and improve health…and are we getting our money's worth? The vast majority of studies concerning health-related apps and wearable devices have small sample sizes and short time spans of 6 months or less, so it is not clear if these durations were determined by lack of consistent use over time. Furthermore, many of the most popular applications have not been subjected to randomized trials. Overall, the small demonstrated improvements in outcomes are often associated with professional involvement from clinicians, coaches, or diabetes educators provided in conjunction with use of mobile health (mHealth) platforms. This paper explores the use of mHealth technologies that address cardiovascular disease/prevention (eg, diabetes, diet, physical activity, and associated weight loss) and discusses the lack of adequate evidence to support even minimal patient investment in mobile applications or wearable devices at this time.
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Greig Health Record for Young Adults: Preventive health care for young adults aged 18 to 24 years.
Greig, AA, Tellier, PP
Canadian family physician Medecin de famille canadien. 2019;(8):539-542
Abstract
OBJECTIVE To describe the Greig Health Record for Young Adults (GHRYA), an evidence-based, peer-reviewed, endorsed guide that can assist providers with age-appropriate screening and counseling. SOURCES OF INFORMATION A literature search was performed by the librarian from the Department of Family and Community Medicine at the University of Toronto in Ontario. PubMed, MEDLINE, the Cochrane Database of Systematic Reviews, and Google Scholar were searched using the terms young adults, emerging adults, preventive services, prevention, screening, and health promotion. Additional searches were performed using the terms mental health, substance use, addictions, sexual health, bullying, abuse, nutrition, sleep, injury prevention, and physical fitness. A total of 521 articles were identified. Articles retained for review were those relevant to young adults and were population studies, guidelines, and systematic reviews. MAIN MESSAGE Recently, there has been a recognition of the unique health care needs of the 18- to 24-year-old age group. Emerging adults have higher risks of health issues including mental illness, substance use, sexually transmitted infections, and risk-taking behaviour. Providing preventive care requires an age-specific approach, especially as contact with health care providers is often infrequent and episodic. Primary care providers who are less familiar with the preventive care needs of young adults can use the GHRYA to guide their interactions with these patients. This new tool is an easy-to-access guide to evidence-based recommendations to be used when patients present to the office or an urgent-care setting and a ready-to-hand place to record prevention strategies when delivered. The tool includes a checklist and 4 pages of resources and recommendations. CONCLUSION The GHRYA is a peer-reviewed, endorsed guide to the provision of prevention and screening for young adults, which provides an approach to patient care but also evidence-based resources.
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Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group.
Hansen, D, Niebauer, J, Cornelissen, V, Barna, O, Neunhäuserer, D, Stettler, C, Tonoli, C, Greco, E, Fagard, R, Coninx, K, et al
Sports medicine (Auckland, N.Z.). 2018;(8):1781-1797
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Abstract
Whereas exercise training is key in the management of patients with cardiovascular disease (CVD) risk (obesity, diabetes, dyslipidaemia, hypertension), clinicians experience difficulties in how to optimally prescribe exercise in patients with different CVD risk factors. Therefore, a consensus statement for state-of-the-art exercise prescription in patients with combinations of CVD risk factors as integrated into a digital training and decision support system (the EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool) needed to be established. EXPERT working group members systematically reviewed the literature for meta-analyses, systematic reviews and/or clinical studies addressing exercise prescriptions in specific CVD risk factors and formulated exercise recommendations (exercise training intensity, frequency, volume and type, session and programme duration) and exercise safety precautions, for obesity, arterial hypertension, type 1 and 2 diabetes, and dyslipidaemia. The impact of physical fitness, CVD risk altering medications and adverse events during exercise testing was further taken into account to fine-tune this exercise prescription. An algorithm, supported by the interactive EXPERT tool, was developed by Hasselt University based on these data. Specific exercise recommendations were formulated with the aim to decrease adipose tissue mass, improve glycaemic control and blood lipid profile, and lower blood pressure. The impact of medications to improve CVD risk, adverse events during exercise testing and physical fitness was also taken into account. Simulations were made of how the EXPERT tool provides exercise prescriptions according to the variables provided. In this paper, state-of-the-art exercise prescription to patients with combinations of CVD risk factors is formulated, and it is shown how the EXPERT tool may assist clinicians. This contributes to an appropriately tailored exercise regimen for every CVD risk patient.
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Use of Preventive Medication in Patients With Limited Life Expectancy: A Systematic Review.
Poudel, A, Yates, P, Rowett, D, Nissen, LM
Journal of pain and symptom management. 2017;(6):1097-1110.e1
Abstract
CONTEXT Optimal prescribing in patients with limited life expectancy (LLE) remains unclear. OBJECTIVES This study systematically reviews the published literature regarding the use of preventive medication in patients with reduced life expectancy. METHODS A systematic literature search was conducted using three databases (MEDLINE, EMBASE, and CINAHL). Articles published in English from January 1995 to December 2015 were retrieved for analysis to identify peer-reviewed, observational studies assessing use of preventive medications in patients with LLE. Inclusion criteria were: patients with a LLE (less than or equal to two years); prescribed/used preventive medications. RESULTS Of the 15 studies meeting our eligibility criteria, six were from inpatient hospital settings, five in palliative care, three in nursing homes, and one in community settings. The most common life-limiting illnesses described in the studies were cancer (n = 6), cardiovascular diseases (n = 4), dementia and cognitive impairment (n = 2), and other life-limiting illnesses (n = 3). Lipid-lowering medications, especially the statins were frequently prescribed preventive medication followed by antiplatelets, angiotensin converting enzyme inhibitors and angiotensin receptor blockers, anti-osteoporosis medications, and calcium channel blockers. Only four studies reported the instances of medication withdrawal. CONCLUSION Patients continue to receive medications that are not prescribed as symptomatic treatment despite having a LLE. Very few rigorous studies have been conducted on minimizing preventive medications in patients with LLE, and expert opinion varies on medication optimization at the end of life. A consensus guideline that addresses this gap is of paramount importance.
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The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.
Hansen, D, Dendale, P, Coninx, K, Vanhees, L, Piepoli, MF, Niebauer, J, Cornelissen, V, Pedretti, R, Geurts, E, Ruiz, GR, et al
European journal of preventive cardiology. 2017;(10):1017-1031
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Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.
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Sugar-sweetened beverage consumption, correlates and interventions among Australian Aboriginal and Torres Strait Islander communities: a scoping review protocol.
Avery, JC, Bowden, JA, Dono, J, Gibson, OR, Brownbill, A, Keech, W, Roder, D, Miller, CL
BMJ open. 2017;(7):e016431
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander communities of Australia experience poorer health outcomes in the areas of overweight and obesity, diabetes and cardiovascular disease. Contributing to this burden of disease in the Australian community generally and in Aboriginal and Torres Strait Islander communities, is the consumption of sugar-sweetened beverages (SSBs). We have described a protocol for a review to systematically scope articles that document use of SSBs and interventions to reduce their consumption with Aboriginal and Torres Strait Islander people. These results will inform future work that investigates interventions aimed at reducing harm associated with SSB consumption. METHODS AND ANALYSIS This scoping review draws on a methodology that uses a six-step approach to search databases including PubMed, SCOPUS, CINAHL, Informit (including Informit: Indigenous Peoples), Joanna Briggs Institute EBP Database and Mura, between January 1980 and February 2017. Two reviewers will be engaged to search for and screen studies independently, using formulated selection criteria, for inclusion in our review. We will include primary research studies, systematic reviews including meta-analysis or meta-synthesis, reports and unpublished grey literature. Results will be entered into a table identifying study details and characteristics, summarised using a Preferred Reporting Items for Systematic Reviews and Meta-Analysis chart and then critically analysed. ETHICS AND DISSEMINATION This review will not require ethics committee review. Results will be disseminated at appropriate scientific meetings, as well as through the Aboriginal and Torres Strait Islander community.
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European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS).
Gorenek, B, Pelliccia, A, Benjamin, EJ, Boriani, G, Crijns, HJ, Fogel, RI, Van Gelder, IC, Halle, M, Kudaiberdieva, G, Lane, DA, et al
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. 2017;(2):190-225
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European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS).
Gorenek, B, Pelliccia, A, Benjamin, EJ, Boriani, G, Crijns, HJ, Fogel, RI, Van Gelder, IC, Halle, M, Kudaiberdieva, G, Lane, DA, et al
European journal of preventive cardiology. 2017;(1):4-40
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A systematic review of economic evaluations of population-based sodium reduction interventions.
Hope, SF, Webster, J, Trieu, K, Pillay, A, Ieremia, M, Bell, C, Snowdon, W, Neal, B, Moodie, M
PloS one. 2017;(3):e0173600
Abstract
OBJECTIVE To summarise evidence describing the cost-effectiveness of population-based interventions targeting sodium reduction. METHODS A systematic search of published and grey literature databases and websites was conducted using specified key words. Characteristics of identified economic evaluations were recorded, and included studies were appraised for reporting quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS Twenty studies met the study inclusion criteria and received a full paper review. Fourteen studies were identified as full economic evaluations in that they included both costs and benefits associated with an intervention measured against a comparator. Most studies were modelling exercises based on scenarios for achieving salt reduction and assumed effects on health outcomes. All 14 studies concluded that their specified intervention(s) targeting reductions in population sodium consumption were cost-effective, and in the majority of cases, were cost saving. Just over half the studies (8/14) were assessed as being of 'excellent' reporting quality, five studies fell into the 'very good' quality category and one into the 'good' category. All of the identified evaluations were based on modelling, whereby inputs for all the key parameters including the effect size were either drawn from published datasets, existing literature or based on expert advice. CONCLUSION Despite a clear increase in evaluations of salt reduction programs in recent years, this review identified relatively few economic evaluations of population salt reduction interventions. None of the studies were based on actual implementation of intervention(s) and the associated collection of new empirical data. The studies universally showed that population-based salt reduction strategies are likely to be cost effective or cost saving. However, given the reliance on modelling, there is a need for the effectiveness of new interventions to be evaluated in the field using strong study designs and parallel economic evaluations.
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Adapting Technological Interventions to Meet the Needs of Priority Populations.
Linke, SE, Larsen, BA, Marquez, B, Mendoza-Vasconez, A, Marcus, BH
Progress in cardiovascular diseases. 2016;(6):630-8
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Cardiovascular diseases (CVD) comprise the leading cause of mortality worldwide, accounting for 3 in 10 deaths. Individuals with certain risk factors, including tobacco use, obesity, low levels of physical activity, type 2 diabetes mellitus, racial/ethnic minority status and low socioeconomic status, experience higher rates of CVD and are, therefore, considered priority populations. Technological devices such as computers and smartphones are now routinely utilized in research studies aiming to prevent CVD and its risk factors, and they are also rampant in the public and private health sectors. Traditional health behavior interventions targeting these risk factors have been adapted for technology-based approaches. This review provides an overview of technology-based interventions conducted in these priority populations as well as the challenges and gaps to be addressed in future research. Researchers currently possess tremendous opportunities to engage in technology-based implementation and dissemination science to help spread evidence-based programs focusing on CVD risk factors in these and other priority populations.