Evaluation of frailty in geriatric patients undergoing cardiac rehabilitation after cardiac procedure:results of a prospective, cross-sectional study

BACKGROUND: Frailty is an indicator of a decline in quality of life and functional capacity in cardiac rehabilitation (CR) patients. Currently, there is no standardized assessment tool for frailty used in CR. The aim of this study was to determine if the Clinical Frailty Scale (CFS) is feasible for assessing frailty in CR.METHODS: Prospective, cross-sectional study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". Patients ≥75 years undergoing CR after cardiac procedure (n=122) were recruited in four German inpatient CR facilities. Assessments included: CFS, Katz-Index, hand grip strength (HGS), Short Physical Performance Battery (SPPB) and six-minute-walk test (6MWT). Outcomes were frailty (CFS≥4) and the correlation of frailty with assessments of functional capacity, activities of daily living and clinical parameters. Statistical analysis included descriptive statistics and correlations, using the spearman correlation coefficient and chi-square test to test for significance.RESULTS: Data from 101 patients (79.9±4.0 years; 63% male) were analyzed. The mean CFS score was 3.2±1.4; 41.6% were defined as frail (CFS≥4). The mean time required to assess the CFS was 0.20 minutes. The findings show that CFS correlates significantly (p&lt;0.001) with the following factors: Katz-Index, HGS, SPPB-Score and 6MWT (r≤-0.575). In addition, CFS correlated with small to moderate effects with co-morbidities (r=0.250), as-needed medications and need for nursing assistance (r≤0.248).CONCLUSIONS: The CFS assessment can be performed in under one minute and it correlates significantly with assessments of functional capacity, activities of daily living and clinical parameters in the CR setting.TRIAL REGISTRATION: German Clinical Trials Register (DRKS; http:// www. drks. de; DRKS00032256). Retrospectively registered on 13 July 2023.</p

An AI-powered data curation and publishing virtual assistant: usability and explainability/causability of, and patient interest in the first-generation prototype

IntroductionEnsuring high quality and reusability of personal health data is costly and time-consuming. An AI-powered virtual assistant for health data curation and publishing could support patients to ensure harmonization and data quality enhancement, which improves interoperability and reusability. This formative evaluation study aimed to assess the usability of the first-generation (G1) prototype developed during the AI-powered data curation and publishing virtual assistant (AIDAVA) Horizon Europe project.MethodsIn this formative evaluation study, we planned to recruit 45 patients with breast cancer and 45 patients with cardiovascular disease from three European countries. An intuitive front-end, supported by AI and non-AI data curation tools, is being developed across two generations. G1 was based on existing curation tools and early prototypes of tools being developed. Patients were tasked with ingesting and curating their personal health data, creating a personal health knowledge graph that represented their integrated, high-quality medical records. Usability of G1 was assessed using the system usability scale. The subjective importance of the explainability/causability of G1, the perceived fulfillment of these needs by G1, and interest in AIDAVA-like technology were explored using study-specific questionnaires.ResultsA total of 83 patients were recruited; 70 patients completed the study, of whom 19 were unable to successfully curate their health data due to configuration issues when deploying the curation tools. Patients rated G1 as marginally acceptable on the system usability scale (59.1 ± 19.7/100) and moderately positive for explainability/causability (3.3–3.8/5), and were moderately positive to positive regarding their interest in AIDAVA-like technology (3.4–4.4/5).DiscussionDespite its marginal acceptability, G1 shows potential in automating data curation into a personal health knowledge graph, but it has not reached full maturity yet. G1 deployed very early prototypes of tools planned for the second-generation (G2) prototype, which may have contributed to the lower usability and explainability/causability scores. Conversely, patient interest in AIDAVA-like technology seems quite high at this stage of development, likely due to the promising potential of data curation and data publication technology. Improvements in the library of data curation and publishing tools are planned for G2 and are necessary to fully realize the value of the AIDAVA solution

Cocreation to Facilitate Communication and Collaboration Between Multidisciplinary Stakeholders in eHealth Research and Development:Case Study of the CARRIER (Coronary Artery Disease: Risk Estimations and Interventions for Prevention and Early Detection) Consortium

BACKGROUND: Collaboration with diverse stakeholders in eHealth research is fundamental yet complex. Stakeholders from various disciplines do not "speak the same language" and have different levels of power and interest, resulting in contrasting objectives, priorities, and expectations. An approach to constructive communication and collaboration is necessary to overcome this complex dynamic. Cocreation, known in the field of eHealth most often to involve end users, may also be suitable for facilitating stakeholder engagement and alignment. OBJECTIVE: This paper provides insights into the application of cocreation, specifically in the early phases of research that focus on involving and aligning relevant stakeholders from different academic and professional backgrounds. METHODS: The case for this study was a group discussion with members of a multidisciplinary consortium that works on developing a personalized eHealth intervention for atherosclerotic cardiovascular disease. Using stakeholder mapping, health and medicine experts, big data scientists, software developers, and an innovation manager (N=8) were invited to participate. The discussion was based on a user scenario and structured according to the Six Thinking Hats of de Bono, representing 6 different types of thinking. The discussion was recorded, transcribed verbatim, and analyzed thematically with the use of ATLAS.ti software. RESULTS: First, informative and intuitive thinking served the preparatory purpose of familiarization with the project details and other participants. Second, positive and critical thinking constituted the body of the discussion and resulted in an in-depth conversation. Third, creative and organizational thinking were action oriented and focused on solutions and planning to safeguard future progress. The participants repeatedly reflected on various intervention-related themes, ranging from intervention content to technical functionalities and from legal requirements to implementation in practice. Moreover, project-related matters were discussed, including stakeholder management and time and budget constraints. CONCLUSIONS: This paper demonstrates how cocreation can be of value for multidisciplinary stakeholder engagement and alignment. Based on stakeholder mapping (with whom to discuss), a dream user scenario (what to discuss), and the Six Thinking Hats of de Bono (how to discuss), the participants shared information, discussed differences, searched for solutions, and moved toward a collective approach regarding intervention development. The lessons learned may further improve the understanding of how cocreation can contribute to multidisciplinary collaboration

Reasons and predictors of non-participation in a personalized digital prehabilitation care trial for patients undergoing elective cardiothoracic surgery

OBJECTIVES: Prehabilitation through a digital platform could preoperatively improve the physical and mental fitness of patients undergoing cardiothoracic surgery, thereby improving treatment outcomes. This study aimed to describe the reasons and predictors of non-participation in a personalized digital prehabilitation care trial (Digital Cardiac Counseling randomized controlled trial) for patients undergoing elective cardiothoracic surgery. METHODS: Adult patients scheduled for elective cardiothoracic surgery at the Maastricht University Medical Center+ were approached to participate in a digital prehabilitation care trial, in which patients were informed about their care pathway, monitored for symptom progression and screened for preoperative modifiable risk factors. Baseline characteristics of all eligible patients and reasons of non-participation were registered prospectively. Predictors of non-participation were determined using logistic regression. RESULTS: Between May 2020 and August 2022, 815 patients were eligible for participation; 421 (52%) did not participate in the personalized digital prehabilitation care trial. Reasons for non-participation were 'lack of internet access or insufficient digital skills' (32%), 'wishing no participation' (39%) and 'other reasons' (30%; e.g. vision or hearing impairments, analphabetism, language barriers). Independent predictors of non-participation were age [odds ratio (OR) 1.024 (1.003-1.046), P?=?0.024], socioeconomic status [OR 0.267 (0.133-0.536), P?&lt;?0.001], current smoker [OR 1.823 (1.124-2.954), P?=?0.015] and EuroSCORE II [OR 1.160 (1.042-1.292), P?=?0.007]. CONCLUSIONS: Half of the eligible patients did not participate in a personalized digital prehabilitation care trial. Non-participants were vulnerable patients, with a more unfavourable risk profile and more modifiable risk factors, who could potentially benefit the most from prehabilitation