Epigenetic dysregulation of energy homeostasis drives aortic valve stenosis that is treatable with metformin.

Aortic valve stenosis is a progressive and increasingly prevalent disease in older adults, with no approved pharmacologic therapies to prevent or slow its progression. Although genetic risk factors have been identified, the contribution of epigenetic regulation remains poorly understood. Here, we demonstrated that histone deacetylase 3 (HDAC3) maintains aortic valve structure by suppressing mitochondrial biogenesis and preserving extracellular matrix integrity in valvular interstitial fibroblasts.

Circulating extra-cellular RNAs and atrial fibrillation: data from the TRACE-CORE cohort.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia and is linked to increased risk of stroke, heart failure, and mortality. Circulating extracellular RNAs (exRNAs), which regulate gene expression and reflect underlying biological processes, are potential biomarkers for atrial fibrillation.

Methods: As part of an ongoing, larger study into extracellular RNAs (exRNAs) as potential biomarkers for cardiovascular disease, we analyzed exRNA profiles in a subset of 296 survivors of acute coronary syndrome (ACS) enrolled in the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) cohort.

ECG Statement Classification and Lead Reconstruction using CNN-based Models.

ECG is an essential diagnostic tool that offers important insight into a person's cardiac and general health. The rise of intelligent wearable devices has opened a new avenue for clinicians and individuals to capture long term ECG data-albeit with fewer leads than the 12 leads that are typically used clinically, which can be vital for identifying and addressing health concerns. In this work, a multi-task convolutional neural network (CNN) classifier was used to study the influence of various combinations of ECG leads in interpretation of 71 cardiac statements spanning cardiac diagnostics, form, and rhythm.

Evaluation of an integrated digital and mobile intervention to improve outcomes for patients with moderate to severe COPD.

Chronic obstructive pulmonary disease (COPD) leads to high rates of emergency department (ED) visits and hospitalizations. This study evaluated a community-based digital health intervention's association with acute care utilization among patients with moderate to severe COPD. In a decentralized, nonrandomized trial, participants received biometric monitoring, symptom tracking, on-demand paramedic services, and digital pulmonary rehabilitation for 6 months.

Mobile applications for atrial fibrillation self-management: a systematic search and evaluation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia, increasing the risk of stroke, heart failure, and healthcare costs. Although patient self-management can improve outcomes, sustaining long-term engagement is often difficult. Mobile health applications may help address this gap, but their quality and clinical alignment have not been systematically assessed using a validated framework.

Healthy at Home for COPD: An Integrated Digital Monitoring, Treatment, and Pulmonary Rehabilitation Intervention.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality in the United States. Frequent exacerbations result in higher use of emergency services and hospitalizations, leading to poor patient outcomes and high costs. The objective of this study is to demonstrate the feasibility of a multimodal, community-based intervention in treating acute COPD exacerbations.

Wearable Irregular Heart Rhythm Detection Recurrences and Electrocardiographic Atrial Fibrillation Confirmation: The Fitbit Heart Study.

Background: Wrist-worn wearables can detect irregular heart rhythms using photoplethysmography, but ECGs are required to confirm atrial fibrillation (AF). We sought to determine the frequency of a recurrent irregular heart rhythm detection (IHRD; ≥30 minutes of an irregular rhythm), estimate the potential diagnostic yield of different electrocardiographic monitoring strategies for confirming AF, and identify predictors of recurrent IHRDs.

Methods: The Fitbit Heart Study enrolled wrist-worn photoplethysmography device users without diagnosed AF.

Identifying a Heterogeneous Effect of Atrial Fibrillation Screening in Older Adults: A Secondary Analysis of the VITAL-AF Trial.

Background: One-time atrial fibrillation (AF) screening trials in older adults have produced mixed results. In a secondary analysis of the VITAL-AF trial, we aimed to identify a subset of people in whom such screening is effective, using effect-based and risk-based approaches.

Methods: The VITAL-AF trial was a cluster-randomized trial of 1-time, 30-second single-lead ECG screening during primary care visits.

Blood Pressure Responses During Exercise Were Associated With Average Home Blood Pressure and Home Blood Pressure Variability: The Electronic Framingham Heart Study.

Background: Abnormal exercise blood pressure (BP) responses are associated with hypertension and cardiovascular disease, but their relationship with home BP over a mid- to long-term time span is unknown.

Methods: At an FHS (Framingham Heart Study) research examination (2016-2019), participants underwent maximum incremental ramp cycle ergometry cardiopulmonary exercise testing with BP measured every 2 minutes. At the same exam, English-speaking participants enrolled in the electronic FHS with an iPhone were provided with a digital BP cuff to measure home BP weekly for 1 year.

Successful Treatment of Ruptured Sinus of Valsalva Aneurysm Associated With Subarterial Ventricular Septal Defect.

• A subarterial VSD may lead to a SOVA or rupture. • Important to exclude a SOVA rupture when continuous flow is seen in subarterial VSD. • Surgical repair is warranted when associated with heart failure symptoms.

Patterns of Adherence to Home Blood Pressure Monitoring Among Men and Women in the Electronic Framingham Heart Study.

Background: Worldwide, there are differences in hypertension control by sex. The use of home blood pressure monitoring (HBPM) is associated with lower average blood pressures and higher medication adherence. However, little is known about adherence trajectories and sex differences in HBPM.

Digital Assessment of Cognitive Health in Outpatient Primary Care: Usability Study.

Background: Screening for cognitive impairment in primary care is important, yet primary care physicians (PCPs) report conducting routine cognitive assessments for less than half of patients older than 60 years of age. Linus Health's Core Cognitive Evaluation (CCE), a tablet-based digital cognitive assessment, has been used for the detection of cognitive impairment, but its application in primary care is not yet studied.

Objective: This study aimed to explore the integration of CCE implementation in a primary care setting.

Sequencing in over 50,000 cases identifies coding and structural variation underlying atrial fibrillation risk.

Atrial fibrillation (AF) is a prevalent and morbid abnormality of the heart rhythm with a strong genetic component. Here, we meta-analyzed genome and exome sequencing data from 36 studies that included 52,416 AF cases and 277,762 controls. In burden tests of rare coding variation, we identified novel associations between AF and the genes MYBPC3, LMNA, PKP2, FAM189A2 and KDM5B.

Meta-analysis of genome-wide associations and polygenic risk prediction for atrial fibrillation in more than 180,000 cases.

Atrial fibrillation (AF) is the most common heart rhythm abnormality and is a leading cause of heart failure and stroke. This large-scale meta-analysis of genome-wide association studies increased the power to detect single-nucleotide variant associations and found more than 350 AF-associated genetic loci. We identified candidate genes related to muscle contractility, cardiac muscle development and cell-cell communication at 139 loci.

Usability and Implementation Considerations of Fitbit and App Intervention for Diverse Cancer Survivors: Mixed Methods Study.

Background: Despite the known benefits of physical activity, cancer survivors remain insufficiently active. Prior trials have adopted digital health methods, although several have been pedometer-based and enrolled mainly female, non-Hispanic White, and more highly educated survivors of breast cancer.

Objective: The objective of this study was to test a previously developed mobile health system consisting of a Fitbit activity tracker and the MyDataHelps smartphone app for feasibility in a diverse group of cancer survivors, with the goal of refining the program and setting the stage for a larger future trial.

Time-Dependent ECG-AI Prediction of Fatal Coronary Heart Disease: A Retrospective Study.

: Fatal coronary heart disease (FCHD) affects ~650,000 people yearly in the US. Electrocardiographic artificial intelligence (ECG-AI) models can predict adverse coronary events, yet their application to FCHD is understudied. : The study aimed to develop ECG-AI models predicting FCHD risk from ECGs.

Multiclass arrhythmia classification using multimodal smartwatch photoplethysmography signals collected in real-life settings.

In the early stages of atrial fibrillation (AF), most cases are paroxysmal (pAF), making identification only possible with continuous and prolonged monitoring. With the advent of wearables, smartwatches equipped with photoplethysmographic (PPG) sensors are an ideal approach for continuous monitoring of pAF. There have been numerous studies demonstrating successful capture of pAF events, especially using deep learning.

Relationship Between Acute SARS-CoV-2 Viral Clearance and Long COVID-19 (Long COVID) Symptoms: A Cohort Study.

Background: The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral dynamics during acute infection and the development of long coronavirus disease 2019 (COVID-19), or "long COVID," is largely unknown.

Methods: Between October 2021 and February 2022, 7361 people not known to have COVID-19 self-collected nasal swab samples for SARS-CoV-2 reverse-transcription polymerase chain reaction testing every 24-48 hours for 10-14 days. Participants whose first known SARS-CoV-2 infection was detected were surveyed for long COVID in August 2023.

Barriers and facilitators to home blood pressure monitoring in women with pregnancies complicated by hypertensive disorders: a qualitative study.

Background/objective: Hypertensive disorders of pregnancy (HDP) are a major cause of maternal morbidity and mortality in the US. Improved diagnosis and treatment of HDP may be achieved through home blood pressure monitoring (HBPM). However, there are challenges to effective HBPM during pregnancy.

A Clinician and Electronic Health Record Wearable Device Intervention to Increase Physical Activity in Patients With Obesity: Formative Qualitative Study.

Background: The number of individuals using digital health devices has grown in recent years. A higher rate of use in patients suggests that primary care providers (PCPs) may be able to leverage these tools to effectively guide and monitor physical activity (PA) for their patients. Despite evidence that remote patient monitoring (RPM) may enhance obesity interventions, few primary care practices have implemented programs that use commercial digital health tools to promote health or reduce complications of the disease.

Implementing virtual desktops for clinical research at an academic health center: a case report.

Objectives: To address the challenges of sharing clinical research data through the implementation of cloud-based virtual desktops, enhancing collaboration among researchers while maintaining data security.

Materials And Methods: This case study details the deployment of virtual desktops at UMass Chan Medical School (UMass Chan). The process involved forming a Research Informatics Steering Executive workgroup, identifying key requirements, implementing Amazon WorkSpaces, and establishing configurable data management for research support.