Getting healthy sleep was recognized in 2022 by the American Heart Association as a key health behavior of Life’s Essential 8 based on growing evidence of its impact on cardiovascular health. American Heart Association guidelines recommend that adults aged ≥20 years get on average 7 to 9 hours of sleep per night, based on self-reported measures. However, many adults report getting inadequate sleep duration, a trend expected to worsen through 2050. For these reasons, the relationship between sleep, including its multidimensional components (eg, timing, efficiency, regularity, and architecture), and cardiovascular disease must be evaluated further. In this review, we summarize the current evidence on the association of multidimensional sleep with heart disease and stroke risk. In addition, we discuss the advantages and limitations of various sleep assessments from self-report to direct measurement via novel digital health technologies.

BACKGROUND:Digital health technologies have become integral to health care delivery, yet significant disparities continue to undermine equitable access and effectiveness. Approximately 16% of adults in the United States lack basic digital health literacy (DHL) skills, with barriers disproportionately affecting older adults, low-income individuals, and minoritized communities. Understanding the relationship between DHL and patient engagement is essential for addressing these inequities. PURPOSE:This integrative review examined the relationship between DHL and patient adherence to follow-up care, self-management behaviors, and telehealth engagement to identify factors contributing to health care disparities in digital health utilization. METHODS:A systematic search was conducted on August 26, 2024, across PubMed, Embase, and CINAHL. Studies published in English from January 2014 to September 2024 were included if they measured DHL using validated instruments or examined telehealth utilization patterns related to patient adherence to follow-up care, self-management behaviors, or telehealth engagement. Fourteen studies met the inclusion criteria and were appraised using the Johns Hopkins Evidence-Based Practice model. RESULTS:Higher DHL was consistently associated with improved patient behaviors, enhanced self-management, including better medication adherence, and improved telehealth engagement. Patients with higher DHL reported greater confidence using digital tools and satisfaction with virtual care. However, disparities remain entrenched, with studies consistently showing that older adults, rural populations, and individuals with lower incomes face greater barriers to effective telehealth engagement. CONCLUSIONS:DHL is a key determinant of equitable telehealth participation and patient outcomes. Integrating DHL assessment and training into routine health care delivery is essential to reducing disparities and advancing health equity.

OBJECTIVES:Medical emergency teams (METs) are activated in response to signs and symptoms, or triggers, of clinical deterioration in acute care settings. However, the patterns in which triggers manifest and impact outcomes are poorly understood. We identified and described the patterns in which multiple triggers cluster to activate pediatric METs and examined the associations between these clusters and outcomes. METHODS:Pediatric MET events from January 2015 to December 2019 in the Get With The Guidelines®-Resuscitation national registry focused on METs (N = 4289) were grouped into MET trigger clusters using cluster analyses based on triggers used to activate the MET. Differences in patient characteristics across MET trigger clusters were compared using Pearson χ2 and analysis of variance (ANOVA) tests. Hierarchical logistic regressions tested associations between trigger clusters and outcomes. RESULTS:A total of 4 MET trigger clusters were identified. The triggers that predominantly defined each cluster were as follows: Cluster 1, decreased oxygen saturation and mental status changes; Cluster 2, tachypnea, tachycardia, and staff concern; Cluster 3, new onset difficulty in breathing and staff concern; and Cluster 4, the reference cluster, tachypnea, new onset difficulty in breathing, and decreased oxygen saturation. Patients in Cluster 1 were more likely to experience acute respiratory compromise (need for emergent assisted ventilation), and patients in Clusters 1 and 3 were more likely to be transferred to critical care. CONCLUSIONS:A total of 4 MET trigger clusters were identified and have varying associations with outcomes. MET trigger clusters could guide bedside care and triage in clinical emergencies and help develop more accurate predictive models for detecting clinical deterioration.

BACKGROUND:African American caregivers disproportionately engage in high-intensity caregiving. Pain experiences of African Americans may interfere with caregiving and overall health, but little is known about the associations of caregiving activities and activity-limiting pain among African Americans. OBJECTIVE:We aimed to 1) examine risk factors for activity-limiting pain among African American caregivers and 2) analyze the relationships between caregiving intensity, patient care needs and activity-limiting pain. METHODS:In a cross-sectional analysis, using nationally representative data from the National Study of Caregiving and linked National Health and Aging Trends Study, we analyzed caregiver and care recipient factors associated with activity-limiting pain among African American caregivers. We examined the relationship between caregiving intensity, patient care needs and activity-limiting pain using multivariable logistic regression. Sampling weights were applied to make nationally representative estimates. RESULTS:Our sample (N = 1673) included mostly female (63.5%) African American caregivers, with a mean age of 55.8 ± 21.5 years. Nearly half experience pain and 11% report activity-limiting pain. In our fully adjusted, multivariable model, those with higher intensity caregiving (i.e., longer duration of caregiving) [aOR: 2.09, CI: 1.29-3.39] and higher patient care needs (i.e., supporting care recipients requiring assistance for more activities of daily living (ADLs)) [aOR: 1.15, CI: 1.02-1.29] had higher odds of activity-limiting pain compared to those with lower intensity caregiving and lower care needs. CONCLUSION:These findings underscore the importance of the intersection of race, caregiving, and pain. Future work should explore how African American caregivers cope with pain and how best to support them.

Background Patient portals are secure online platforms that have shown potential to facilitate shared decision‐making (SDM) in cardiovascular disease risk reduction. However, the role of health care providers (HCPs) in offering patient portals within the context of SDM remains poorly understood. This study aimed to examine the relationship between patient portal access offered by HCPs and patient engagement in SDM among adults with or at risk of cardiovascular disease in the United States (US). Methods This population‐based cross‐sectional study included a nationally representative sample of US adults from the 2022 Health Information National Trends Survey. We performed weighted multivariable logistic regression analyses to examine the association between patient portal access offered by HCPs and patient engagement in SDM. Results The study included a representative sample of 4234 adults with or at risk of cardiovascular disease. The mean age of the participants was 48.5 years (SD, 17.1), with 50.6% female and 62.8% White. Adults who were offered access to patient portals by HCPs (adjusted odds ratio, 2.11 [95% CI, 1.34–3.32]) and encouraged to use them (adjusted odds ratio, 1.68 [95% CI, 1.15–2.45]) were more likely to engage in SDM than their counterparts, adjusting for covariates. The extent of this association varied by demographics and social determinants of health. Conclusions Offering access to patient portals and encouragement to use them by HCPs was associated with high SDM among US adults with or at risk of cardiovascular disease. Future research is needed to explore the possible causal relationship between patient portal use and access and patient engagement in SDM.

BACKGROUND:Although telehealth cardiac rehabilitation (CR) may improve access, there are concerns about its long-term effectiveness and impact on equity as compared with in-person CR. Our objective was to tailor a patient-centered telehealth CR program for diverse populations. METHODS:CR patients and caregivers were recruited between January and September 2023 from 4 US academic medical centers. Participants engaged in human-centered design sessions to iteratively refine a telehealth CR program. Sessions had planned topics, but there was variation across sites to account for site-specific needs and participant feedback. Sessions were qualitatively analyzed using rapid template analysis with preselected behavioral science constructs and other emergent codes. RESULTS:The study included 21 participants (71% aged ≥60 years, 48% women, 62% non-Hispanic White individuals; 90% CR patients, 10% CR caregivers). Participants thought that telehealth CR could be helpful for personalized support at home and convenience but recognized that technology is not always easy to use. Some expressed concerns about the safety of telehealth CR, especially at the beginning, and desired monitoring through a mobile device or video observation of exercise. Safety protocols and technology training were developed, which addressed concerns about telehealth CR. Opportunities for social support with telehealth CR were also desired. From these findings, an implementation toolkit was developed, including a graphic program description, safety plan, home exercise plan for during and after CR, and scripts for technology training and individual and group telehealth visits. CONCLUSIONS:A patient-centered telehealth CR program and implementation toolkit were systematically tailored to address the needs of diverse populations.

BACKGROUND:Digital health technologies provide a scalable, efficient approach to implementing guideline-recommended risk factor modification in the care of patients with atrial fibrillation (AF). OBJECTIVES:This study aimed to evaluate the feasibility of a 12-week, multicomponent, virtual AF management program using a smartphone application, connected devices, and virtual coaching calls for risk factor modification. METHODS:Patients with AF were enrolled from outpatient clinics. Patients were randomized in a 1:1 ratio to either usual care only or the virtual program. The study objectives were to assess feasibility, with the goal of achieving at least 60% participant retention at 12 weeks, intervention engagement, and participant satisfaction. RESULTS:Among 61 patients enrolled (76% of those approached), the mean age was 65 ± 8 years, and 36% were women. A total of 89% of all participants were retained by 12-week follow-up. In the intervention group, at 12-weeks, 88% continued using the smartphone application, 73% continued participation in virtual coaching calls, and 80% reported being satisfied with the program. CONCLUSIONS:The mTECH Afib (Patient Centered mobile health TECHnology Enabled Atrial Fibrillation Management) trial demonstrates feasibility of conducting a randomized controlled trial using an innovative digital health technology-enabled intervention with broad patient engagement and acceptance of the program components. Large-scale clinical trials powered for health outcomes will be necessary to establish intervention efficacy.

Background While the positive effects of digital technology on cognitive function are established, the specific impacts of different types of technology activities on distinct cognitive domains remain underexplored. Objective This study aimed to examine the associations between transitions into and out of various technology activities and trajectories of cognitive domains among community-dwelling older adults without dementia. Method Data were drawn from 5566 community-dwelling older adults without dementia who participated in the National Health and Aging Trends Study from 2015 to 2022. Technology activities assessed included online shopping, banking, medication refills, social media use, and checking health conditions online. The cognitive domains measured were episodic memory, executive function, and orientation. Asymmetric effects models were used to analyze the associations between technology activity transitions and cognitive outcomes, adjusting for demographic, socioeconomic, and health-related covariates. Lagged models were applied for sensitivity analysis. Results In the asymmetric effects models, the onset of online shopping (β=.046, P=.02), medication refills (β=.073, P<.001), and social media use (β=.065, P=.01) was associated with improved episodic memory. The cessation of online shopping was associated with faster episodic memory decline (β=−.023, P=.047). In contrast, the cessation of online banking (β=−.078, P=.01) and social media use (β=−.066, P=.003) was associated with decreased episodic memory. The initiation of instrumental, social, and health-related technology activities was associated with slower cognitive decline in orientation. The lagged models further emphasized the effects of stopping online banking and starting online medication refills in relation to episodic memory, as well as the positive associations between online shopping and social media use and orientation. All significant effects were of small magnitude. Conclusions Combining findings from the main and sensitivity analyses, results suggest that interventions designed to support episodic memory in older adults should emphasize promoting the use of online medication refill services and sustaining engagement with online banking, particularly among those who have already established these habits. To support orientation, strategies should focus on facilitating adoption of online shopping and social media use, helping older adults become comfortable navigating these platforms. Future trials are needed to assess the clinical relevance of targeted interventions for specific cognitive domains, to promote the initiation and maintenance of digital activities to help mitigate domain-specific cognitive decline in aging populations.

Importance Black persons, including immigrants, in the US disparately experience poor cardiometabolic health (CMH). Limited research on the effect of lifestyle interventions that improve CMH among African immigrant populations is available. Objective To test the effectiveness of a culturally adapted, virtual lifestyle intervention on control of blood pressure (BP) and hemoglobin A1c (HbA1c) levels among African immigrants with CMH risk factors. Design, Setting, and Participants Afro-DPP (Diabetes Prevention Program), a pilot cluster-randomized clinical trial, evaluated the effectiveness of a multicomponent CMH intervention. The study took place in 2 churches with predominantly African immigrant congregations in the Baltimore-Washington, DC, metropolitan area from January 1, 2022, to July 31, 2023. Participants were adults aged 25 to 75 years with at least 2 CMH risk factors who self-identified as African immigrants and belonged to the participating churches. Analyses followed the intention-to-treat principle. Intervention Participants received a 6-month culturally adapted lifestyle intervention based on the National DPP curriculum, delivered via virtual group sessions by a lifestyle coach of African origin. The delayed intervention began 6 months later with a follow-up time of 6 months. The intervention also included remote BP and weight monitoring. Main Outcome and Measures Primary outcomes were changes in systolic and diastolic BP and HbA1c levels from baseline to 6 months. Secondary outcomes included reduced body weight and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). Results The analytic population included 60 participants (mean [SD] age, 50.6 [11.9] years; 40 [66.7%] women). In the first intervention group (n = 30), systolic BP decreased by 9.2 (95% CI, 2.5-15.9) mm Hg, diastolic BP by 6.1 (95% CI, 2.1-10.0) mm Hg, body weight by 4.9 (95% CI, 1.0-8.7) kg, and BMI by 1.1 (95% CI, 0.4-1.7) at 6 months. In the delayed intervention group (n = 30), systolic BP decreased by 11.4 (95% CI, 2.4-20.5) mm Hg, diastolic BP by 10.3 (95% CI, 5.4-15.2) mm Hg, and body weight by 3.3 (95% CI, 0.01-6.5) kg, while BMI increased by 0.3 (95% CI, -1.5 to 2.0). Conclusions and Relevance Trial findings indicate that interventions incorporating cultural adaptation and virtual components could help address CMH disparities in this population.

Black persons, including immigrants, in the US disparately experience poor cardiometabolic health (CMH). Limited research on the effect of lifestyle interventions that improve CMH among African immigrant populations is available. To test the effectiveness of a culturally adapted, virtual lifestyle intervention on control of blood pressure (BP) and hemoglobin A1c (HbA1c) levels among African immigrants with CMH risk factors. Afro-DPP (Diabetes Prevention Program), a pilot cluster-randomized clinical trial, evaluated the effectiveness of a multicomponent CMH intervention. The study took place in 2 churches with predominantly African immigrant congregations in the Baltimore–Washington, DC, metropolitan area from January 1, 2022, to July 31, 2023. Participants were adults aged 25 to 75 years with at least 2 CMH risk factors who self-identified as African immigrants and belonged to the participating churches. Analyses followed the intention-to-treat principle. Participants received a 6-month culturally adapted lifestyle intervention based on the National DPP curriculum, delivered via virtual group sessions by a lifestyle coach of African origin. The delayed intervention began 6 months later with a follow-up time of 6 months. The intervention also included remote BP and weight monitoring. Primary outcomes were changes in systolic and diastolic BP and HbA1c levels from baseline to 6 months. Secondary outcomes included reduced body weight and body mass index (BMI; calculated as weight in kilograms divided by height in meters squared). The analytic population included 60 participants (mean [SD] age, 50.6 [11.9] years; 40 [66.7%] women). In the first intervention group (n = 30), systolic BP decreased by 9.2 (95% CI, 2.5-15.9) mm Hg, diastolic BP by 6.1 (95% CI, 2.1-10.0) mm Hg, body weight by 4.9 (95% CI, 1.0-8.7) kg, and BMI by 1.1 (95% CI, 0.4-1.7) at 6 months. In the delayed intervention group (n = 30), systolic BP decreased by 11.4 (95% CI, 2.4-20.5) mm Hg, diastolic BP by 10.3 (95% CI, 5.4-15.2) mm Hg, and body weight by 3.3 (95% CI, 0.01-6.5) kg, while BMI increased by 0.3 (95% CI, −1.5 to 2.0). Trial findings indicate that interventions incorporating cultural adaptation and virtual components could help address CMH disparities in this population. ClincalTrials.gov Identifier NCT05144737

Background: Hybrid cardiac rehabilitation (HCR) is an emerging approach to increase participation in cardiac rehabilitation, which targets improvements in functional status and broader risk factor modification including lipid management. However, long-term lipid control trends of patients engaging in HCR remain unexplored. Methods: Using data from a quality improvement program initiated during COVID-19, we conducted a retrospective analysis of 68 adults eligible for HCR from Jan 2021 to Feb 2023 at the Johns Hopkins Health System (Baltimore, MD), utilizing the Corrie digital health platform. This multi-component platform combines expert knowledge with gamified education and virtual coaching to deliver HCR. Patients hospitalized for cardiovascular events qualifying for HCR were recruited for a pilot study of a randomized controlled trial (mTECH REHAB; NCT05238103). We modeled trends in low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, and triglycerides via mixed-effects regression. Results: Among 68 eligible adults, 41 participated in HCR, with a mean age of 60.1 years, 78.1% male, 24.3% Black, and 14.6% Asian/Mixed. HCR participation was significantly associated with being married (61% vs 33%, p=0.044) or employed (63% vs 26%, p=0.015). On average, 2.3 lipid panels were assessed per person over a median of 12 months (max 30 months) post-discharge. During this period, LDL-C levels decreased from 84.6 mg/dL (95% CI: 75.0-94.1) to 53.0 mg/dL (95% CI: 34.3-71.8) (p for trend = 0.003). Non-HDL-C decreased from 105.9 mg/dL (95% CI: 95.7-116.1) to 74.2 mg/dL (95% CI: 54.1-94.3) (p for trend = 0.005). Levels of HDL-C and triglycerides showed no significant changes (p for trend = 0.724 and 0.607). Among 34 participants with ≥2 lipid panels, the proportion of LDL-C <70 mg/dL increased from 41.2% at hospitalization to 64.7% at the most recent check, and LDL-C <55 mg/dL increased from 14.7% to 38.2%. Conclusion: Improvements in atherogenic lipid levels, in particular LDL-C and non-HDL-C, were observed in adults participating in HCR after a cardiovascular event. Our findings highlight the potential of HCR to support optimal lipid management in adults with cardiovascular disease.

Background: Telehealth use remains high following the COVID-19 pandemic, but patient satisfaction with telehealth care is unclear. Methods: We used cross-sectional data from the Health Information National Trends Survey (HINTS 6). 2,058 English and Spanish-speaking U.S. adults (≥18 years) with a telehealth visit in the 12 months before March-November 2022 were included in this study. The primary outcomes were telehealth visit modality and satisfaction in the 12 months before HINTS 6. We evaluated sociodemographic predictors of telehealth visit modality and satisfaction via Poisson regression. Analyses were weighted according to HINTS standards. Results: We included 2,058 participants (48.4 ± 16.8 years; 57% women; 66% White), of which 70% had an audio-video and 30% an audio-only telehealth visit. Adults with an audio-video visit were more likely to have health insurance (adjusted prevalence ratio [aPR]: 1.55, 95% confidence interval [CI]: 1.18-2.04) and have an annual household income of ≥$75,000 (aPR: 1.18, 95% CI: 1.00-1.39) and less likely to be ≥65 years (aPR: 0.79, 95% CI: 0.70-0.89), adjusting for sociodemographic characteristics. No further inequities were noted by telehealth modality. Seventy-five percent of participants felt that their telehealth visits were as good as in-person care. No significant differences in telehealth satisfaction were observed across sociodemographic characteristics, telehealth modality, or the participants' primary reason for their most recent telehealth visit in adjusted analysis. Conclusions: Among U.S. adults with a telehealth visit, the majority had an audio-video visit and were satisfied with their care. Telehealth should continue, being offered following COVID-19, as it is uniformly valued by patients.

BACKGROUND:Prior studies have shown that cardiovascular disease (CVD) can be effectively managed through telehealth. However, there are little national data on the use of telehealth in people with CVD or CVD risk factors. We aimed to determine the prevalence of telehealth visits and visit modality (video versus audio-only) in people with CVD and CVD risk factors. We also assessed their rationale and satisfaction with telehealth visits. METHODS AND RESULTS:A nationally representative sample of 6252 participants from the 2022 Health Information National Trends Survey 6 was used. We defined the CVD risk categories as having no self-reported CVD (coronary heart disease or heart failure) or CVD risk factors (hypertension, diabetes, obesity, or current smoking), CVD risk factors alone, and CVD. Multivariable logistic regression, adjusting for major sociodemographic factors, assessed the relationship between CVD risk and telehealth uptake. The weighted prevalence of using telehealth was 50% (95% CI, 44%-56%) for individuals with CVD and 40% (95% CI, 37%-43%) for those with CVD risk factors alone. Individuals with CVD had the highest odds of using any telehealth (audio-only or video) (adjusted odds ratio [OR], 2.02 [95% CI, 1.39-2.93]) when compared with those without CVD or CVD risk factors. Notably, 21% (95% CI, 16.3%-25.6%) of patients with CVD used audio-only visits (adjusted OR, 2.38 [95% CI, 1.55-3.64]) compared with patients without CVD or CVD risk factors. CONCLUSIONS:In a nationally representative survey, there was high prevalence of any (video or audio-only) telehealth visits in people with CVD, and audio-only visits comprised a significant proportion of telehealth visits in this population.

BackgroundTelemedicine expanded during the COVID-19 pandemic, though use differed by age, sex, race or ethnicity, educational attainment, income, and location. It is unclear if high telehealth use or inequities persisted late into the pandemic. ObjectiveThis study aims to evaluate the prevalence of, inequities in, and primary reasons for telehealth visits a year after telemedicine expansion. MethodsWe used cross-sectional data from the 2022 Health Information National Trends Survey (HINTS 6), the first cycle with data on telemedicine. In total, 4830 English- and Spanish-speaking US adults (aged ≥18 years) were included in this study. The primary outcomes were telehealth visit attendance in the 12 months before March 7, 2022, to November 8, 2022, and the primary reason for the most recent telehealth visit. We evaluated sociodemographic and clinical predictors of telehealth visit attendance and the primary reason for the most recent telehealth visit through Poisson regression. Analyses were weighted according to HINTS 6 standards. ResultsWe included 4830 participants (mean age 48.3, SD 17.5 years; 50.28% women; 65.21% White). Among US adults, 38.78% reported having a telehealth visit in the previous year. Telehealth visit attendance rates were similar across age, race or ethnicity, income, and urban versus rural location. However, individuals with a telehealth visit were less likely to live in the Midwest (adjusted prevalence ratio [aPR] 0.65, 95% CI 0.54-0.77), and more likely to be women (aPR 1.21, 95% CI 1.06-1.38), college graduates or postgraduates (aPR 1.24, 95% CI 1.05-1.46), covered by health insurance (aPR 1.56, 95% CI 1.08-2.26), and married or cohabitating (aPR 1.17, 95% CI 1.03-1.32), adjusting for sociodemographic characteristics, frequency of health care visits, and comorbidities. Among participants with a telehealth visit in the past year, the primary reasons for their most recent visit were minor or acute illness (32.15%), chronic disease management (21%), mental health or substance abuse (16.94%), and an annual exam (16.22%). Older adults were more likely to report that the primary reason for their most recent telehealth visit was for chronic disease management (aPR 2.08, 95% CI 1.33-3.23), but less likely to report that it was for a mental health or substance abuse issue (aPR 0.19, 95% CI 0.10-0.35), adjusting for sociodemographic characteristics and frequency of health care visits. ConclusionsAmong US adults, telehealth visit attendance was high more than a year after telemedicine expansion and did not differ by age, race or ethnicity, income, or urban versus rural location. Telehealth could continue to be leveraged following COVID-19 to improve access to care and health equity.

Digital health disparities continue to affect marginalized populations, especially older adults, individuals with low-income, and racial/ethnic minorities, intensifying the challenges these populations face in accessing healthcare. Bridging this digital divide is essential, as digital access and literacy are social determinants of health that can impact digital health use and access to care. This article discusses the potential of leveraging community Wi-Fi and spaces to improve digital access and digital health use, as well as the challenges and opportunities associated with this strategy. The existing limited evidence has shown the possibility of using community Wi-Fi and spaces, such as public libraries, to facilitate telehealth services. However, privacy and security issues from using public Wi-Fi and spaces remain a concern for librarians and healthcare professionals. To advance digital equity, efforts from multilevel stakeholders to improve users’ digital access and literacy and offer tailored technology support in the community are required. Ultimately, leveraging community Wi-Fi and spaces offers a promising avenue to expand digital health accessibility and use, highlighting the critical role of collaborative efforts in overcoming digital health disparities.