Background Heart failure (HF) is a chronic disease characterized by high mortality and healthcare expenditures. Digital health solutions, including mobile health applications (apps), offer opportunities to enhance patients’ self-care and quality of life. This qualitative study aimed to explore expectations, experiences, and usage behaviour of HF-patients regarding a self-care app ( DoctorME app). Methods Semi-structured interviews were conducted at 2-3 weeks (initial: n = 38), and 4–6 months (post: n = 45) of app use across four European countries. Most patients were male (initial: 84%; post: 78%), aged 60–69 years (initial and post: 29%), with mild HF symptoms. Interviews were transcribed, pseudonymised, and analysed using qualitative content analysis. Results Five key themes were identified: 1) expectations , 2) perceived usability and benefit, 3) usage behaviour and experiences, 4) self-care, and 5) social influences. Patients expected and valued continuous monitoring of vital signs and weight, early detection of deterioration, and quick feedback. The app was considered user-friendly, with most patients using it as recommended (eight times per month). Those reporting improved self-care attributed it to increased awareness and a sense of security. Patients with established self-care routines did not perceive any additional benefit. Patients’ perceptions on the impact of healthcare professionals’ and relatives opinions on app use were divided. Conclusions User-friendliness, continuous monitoring, rapid feedback, and e-learning modules are crucial for integrating self-care apps into daily HF care. While technical reliability and individualisation may enhance long-term use, most HF patients considered the app as a complement to, not a replacement for, professional healthcare guidance.

Aims Heart failure is an escalating burden on global healthcare systems. Modernizing heart failure care is inevitable, with eHealth products poised to play an important role. However, eHealth devices that can initiate and adjust heart failure medication are currently lacking. Consequently, this study aimed to develop an artificial intelligence-based decision engine to provide guideline-based recommendations for disease-modifying medication in heart failure patients.Methods and results We developed the decision engine by converting the European Society of Cardiology (ESC) heart failure guidelines into Business Process Model and Notation, a visual modelling language suitable for developing complex decision engines. A safety evaluation, based on clinical parameters, was conducted to ascertain the system's applicability to specific cases. The decision engine renders specific decisions concerning disease- modifying therapy for heart failure patients. We defined 72 virtual heart failure patient scenarios, encompassing a broad spectrum of baseline characteristics and background medication. All recommendations offered by the engine were evaluated by an independent heart failure specialist. All but three recommendations (94%) were identical to the treatment decisions by the heart failure specialist, and all (100%) were in line with the 2021 ESC heart failure guidelines.Conclusion The decision engine offers guideline-based recommendations for disease-modifying therapy, positioning it as a tool to enhance self-care among heart failure patients. To validate our results, the decision engine is being prospectively tested in real-world patients in a multicentre clinical trial (NCT04699253).

Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other's experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills.

Background: The heart failure (HF) virtual consultation (VC) is an eHealth tool for delivery of peer-to-peer specialist advice to general practitioners (GPs) to discuss HF diagnosis/management. We aim to investigate the impact of the VC service on onward referral rate and quality of assessment by GPs, as well as assess VC patient characteristics; Clinical Frailty Score (CSF), age and morbidity.Methods: This prospective observational study collected VC data on: demographics, comorbidity, frailty, referral indication, the impact of VC on clinical care and the GP response to the question ‘what would you have done without the VC service’. We compared patient characteristics to a control population of patients attending the HF unit (HFU) (n=118).Reults: Between 2015 and 2021, 1681 VC cases were discussed. The majority of cases were discussed from remote areas (75%). Rediscussion cases increased from 0% to 34%. VC patients were older (76.2 (±11.3) vs 73.1 (±12.5) years, p<0.05), more frail (CSF=3.8 (±1.7) vs 3 (±1.6), p<0.01) and multimorbid (number of comorbidities=7.1 (±3.4) vs 3.8 (±1.9), p<0.001) compared with patients attending the HFU. Without the VC, 93% of cases would have been referred to face-to-face hospital services. Instead, VC resulted in only 9% of cases being referred to hospital services. The remainder of cases were managed by the VC service, in a shared GP-specialist approach. GP use of natriuretic peptide (NP) increased from 0% in 2015–2016 to 63% in 2021 and use of TTE increased from 0% in 2015–2016 to 69% by 2021.Conclusions: The VC service provides a platform for case discussion in particular for older, frailer patients and reduces onward hospital referrals. This may facilitate early diagnosis and management of suspected HF in the current era of long outpatient waiting times. The quality of community HF assessment improved as indicated by increased use of NP/TTE by GPs.

Objective Heart failure is a growing challenge to healthcare systems worldwide. Technological solutions have the potential to improve the health of patients and help to reduce costs. Acceptability is a prerequisite for the use and a successful implementation of new disruptive technologies. This qualitative study aimed to explore determinants that influence the acceptance of patients and their informal caregivers regarding a patient-oriented digital decision-making solution—a doctor-at-home system.Design We applied a semistructured design using an interview guide that was based on a theoretical framework influenced by established acceptance theories. The interviews were analysed using a content analysis.Setting A multicentred study in four European countries.Participants We interviewed 49 patients and 33 of their informal caregivers. Most of the patients were male (76%) and aged between 60 and 69 years (43%). Informal caregivers were mostly female (85%). The majority of patients (55%) suffered from heart failure with mild symptoms.Results Four main categories emerged from the data: needs and expectations, preferences regarding the care process, perceived risk and trust. Participants expressed clear wishes and expectations regarding a doctor-at-home, especially the need for reassurance and support in the management of heart failure. They were receptive to changes to the current healthcare processes. However, trust was identified as an important basis for acceptance and use. Finally, perceived risk for decision-making errors is a crucial topic in need of attention.Conclusion Patients and informal caregivers see clear benefits of digitalisation in healthcare. They perceive that an interactive decision-making system for patients could empower and enable effective self-care. Our results provide important insights for development processes of patient-centred decision-making systems by identifying facilitators and barriers for acceptance. Further research is needed, especially regarding the influence and mitigation of patients and informal caregivers’ perceived risks.

Despite significant advances in disease modifying therapy in heart failure (HF), diuretics have remained the cornerstone of volume management in all HF phenotypes. Diuretics, alongside their definite acute haemodynamic and symptomatic benefits, also possess many possible deleterious side effects. Moreover, questions remain regarding the prognostic impact of chronic diuretic use. To date, few data exist pertaining to diuretic reduction as a result of individual traditional guideline directed medical therapy in HF with reduced ejection fraction (HFrEF). However, diuretic reduction has been demonstrated with sacubitril/valsartan (angiotensin receptor-neprilysin inhibitor [ARNi]) from the PARADIGM study, as well as, post-marketing reports from our own group and others. Whether the ARNi compound represents the dawn of a new era, where effective therapies will have a more noticeable reduction on diuretic need, remains to be seen. The emergence of sodium glucose transport 2 inhibitors and guanylate cyclase stimulators may further exemplify this issue and potentially extend this benefit to HF patients outside of the HFrEF phenotype. In conclusion, emerging new therapies in HFrEF could reduce the reliance on diuretics in the management of this phenotype of HF. These developments further highlight the clinical importance to continually assess an individual's diuretic requirements through careful volume assessment.

BACKGROUND:The COVID pandemic has challenged the traditional methods used in care of patients with heart failure (HF). Remote management of HF patients has been recommended in order to maintain routine standards of care, but satisfaction with this platform of care is unknown. We set out to address the physician and patient opinion of remote management of HF during COVID-19.METHODS AND RESULTS:An observational report of the use of a Structured Telephonic assessment (STA) in stable outpatient HF patients. Physician grading of the STA was complemented by 100 randomly chosen patients to ascertain patient satisfaction and comment. 278 patients underwent a STA. Patient preference for STA was noted in 66%. Convenience was the single most cited reason for this preference (83.3%). The STA was deemed satisfactory by clinicians in 67.6%. The two-leading reasons for clinician dissatisfaction were data gaps providing a barrier to titration (55.6%) and need for clinical exam (18.9%). The annual review appointment visit subtype possessed the highest levels of satisfaction congruence amongst both clinicians and patients.CONCLUSION:In summary, this report demonstrates reasonable patient / physician satisfaction with STA, and provides some direction on how this care platform might be sustained beyond the COVID crisis.

Movement DisordersVolume 35, Issue 7 p. 1286-1286 Letters: Published Articles Reply to: Exercise for “Sleep Rehabilitation” in Parkinson's Disease Amy W. Amara MD, PhD, Corresponding Author amyamara@uab.edu Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USACorrespondence to: Dr. Amy W. Amara, SC360A, 1720 2nd Ave. S, Birmingham, AL 35294-0017, USA; E-mail: amyamara@uab.eduSearch for more papers by this authorKimberly H. Wood PhD, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Psychology, Samford University, Birmingham, Alabama, USASearch for more papers by this authorAllen Joop MS, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorRaima A. Memon MD, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorJennifer Pilkington, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorS. Craig Tuggle MA, University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorJohn Reams MA, University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorMatthew J. Barrett MD, Department of Neurology, University of Virginia, Charlottesville, Virginia, USASearch for more papers by this authorDavid A. Edwards PhD, Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USASearch for more papers by this authorArthur L. Weltman PhD, Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USASearch for more papers by this authorChristopher P. Hurt PhD, University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorGary Cutter PhD, University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorMarcas M. Bamman PhD, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USASearch for more papers by this author Amy W. Amara MD, PhD, Corresponding Author amyamara@uab.edu Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USACorrespondence to: Dr. Amy W. Amara, SC360A, 1720 2nd Ave. S, Birmingham, AL 35294-0017, USA; E-mail: amyamara@uab.eduSearch for more papers by this authorKimberly H. Wood PhD, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Psychology, Samford University, Birmingham, Alabama, USASearch for more papers by this authorAllen Joop MS, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorRaima A. Memon MD, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorJennifer Pilkington, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorS. Craig Tuggle MA, University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorJohn Reams MA, University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorMatthew J. Barrett MD, Department of Neurology, University of Virginia, Charlottesville, Virginia, USASearch for more papers by this authorDavid A. Edwards PhD, Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USASearch for more papers by this authorArthur L. Weltman PhD, Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USASearch for more papers by this authorChristopher P. Hurt PhD, University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorGary Cutter PhD, University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USASearch for more papers by this authorMarcas M. Bamman PhD, Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA University of Alabama, Center for Exercise Medicine, Birmingham, Alabama, USA Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USASearch for more papers by this author First published: 21 July 2020 https://doi.org/10.1002/mds.28132 Relevant conflicts of interests/financial disclosures:: Nothing to report. Funding agencies:: This study was funded by the National Institutes of Health (K23NS080912, T32 HD071866), Parkinson's Disease Foundation, The Manning Foundation, The Curry Foundation at the University of Virginia, UAB Center for Exercise Medicine, and the National Institutes of Health National Rehabilitation Research Resource to Enhance Clinical Trials (REACT, P2CHD086851). Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume35, Issue7July 2020Pages 1286-1286 RelatedInformation

Heart failure (HF) is one of the most complex chronic disorders with high prevalence, mainly due to the ageing population and better treatment of underlying diseases. Prevalence will continue to rise and is estimated to reach 3% of the population in Western countries by 2025. It is the most important cause of hospitalisation in subjects aged 65 years or more, resulting in high costs and major social impact. The current “one-size-fits-all” approach in the treatment of HF does not result in best outcome for all patients. These facts are an imminent threat to good quality management of patients with HF. An unorthodox approach from a new vision on care is required. We propose a novel predictive, preventive and personalised medicine approach where patients are truly leading their management, supported by an easily accessible online application that takes advantage of artificial intelligence. This strategy paper describes the needs in HF care, the needed paradigm shift and the elements that are required to achieve this shift. Through the inspiring collaboration of clinical and high-tech partners from North-West Europe combining state of the art HF care, artificial intelligence, serious gaming and patient coaching, a virtual doctor is being created. The results are expected to advance and personalise self-care, where standard care tasks are performed by the patients themselves, in principle without involvement of healthcare professionals, the latter being able to focus on complex conditions. This new vision on care will significantly reduce costs per patient while improving outcomes to enable long-term sustainability of top-level HF care.

RESULTS: The primary endpoint TLR at 9 months was not significantly different between NRF, CRI and DD patients (2.2% vs. 4.3% vs. 2.2%, p1⁄40.969). As compared to patients with NRF, the 9-month MACE rate in the CRI group was significantly higher (10.3% vs. 3.9%, p1⁄40.001) whereas the 9-month MACE rate in the DD group was only numerically higher (3.9% vs. 6.7, p1⁄40.348), However, the accumulated stent thrombosis (ST) rates were significantly higher in the DD group (4.4%) as compared to the NRF (0.6%) and the CRI groups (0.9%, p<0.001).Table: Clinical outcomes up to 9 months of follow-up (MACE: major adverse cardiac events, TLR: target lesion revascularization; MI: myocardial infarction; PCI: percutaneous intervention; CABG: coronary artery bypass graft).