Risultati per: Passo 10. Intervenire sul singolo paziente in visita: GPG Patient

Circulation, Volume 150, Issue Suppl_1, Page A4140097-A4140097, November 12, 2024. Introduction:The MI-GENES randomized clinical trial (NCT01936675) assessed the effect of disclosing a polygenic risk score (PRS) for coronary heart disease (CHD), in addition to a clinical risk based on Framingham risk score (FRS), on LDL-C levels. The trial enrolled participants from Olmsted County, Minnesota, without cardiovascular disease, at intermediate CHD risk (10-y risk: 5-20%), and not on statins. There was a significant LDL-C reduction in the integrated risk score group (IRSg; received PRS information in addition to the FRS) compared to the FRS group (FRSg; received their risk based on FRS), due to more frequent statin initiation.Research Question:Does disclosure of an IRS for CHD lead to a lower rate of major adverse cardiovascular events (MACE)?Methods:Participants were followed from randomization beginning in October 2013 until September 2023 to ascertain cardiovascular events, testing for CHD, and risk factor changes, by blinded review of electronic health records. The primary outcome was time from randomization to the first MACE— defined as cardiovascular death, nonfatal MI, coronary revascularization, and nonfatal stroke. Analyses were done using Cox and linear mixed-effects models.Results:We followed all 203 participants, who completed the MI-GENES trial, 100 in FRSgand 103 in IRSg(mean age at the end of follow-up 68.2±5.2 years, 48% male). During a median follow-up of 9.5 years, 9 MACE occurred in FRSgand 2 in IRSg(HR, 0.20; 95% CI, 0.04 to 0.94;P=0.042, Figure 1A). In FRSg, 47 (47%) underwent at least one test for CHD, compared to 30 (29%) in IRSg(HR, 0.51; 95% CI, 0.32 to 0.81;P=0.004, Figure 1B). IRSgparticipants had a longer duration of statin therapy during the first four years post-randomization (Figure 1C) and a greater reduction in LDL-C for up to 3 years post-randomization (Figure 1D). No significant differences between the two groups were observed for hemoglobin A1C, blood pressure, weight, and smoking cessation rate during follow-up.Conclusion:The disclosure of 10-year CHD risk that included a PRS to those at intermediate risk was associated with lower incidence of MACE after a decade, likely due to more frequent and prolonged statin use, leading to lower LDL-C levels.

Circulation, Volume 150, Issue Suppl_1, Page A4139306-A4139306, November 12, 2024. Introduction:Although home-based diagnostics have dramatically reshaped care delivery, greater patient activation could affect compliance. For home enrollment and activation (HE) of long-term continuous ambulatory cardiac monitoring (LTCM) devices, patients must receive the device by mail, self-apply the patch, wear it for up to 14 days, and return by mail for ECG interpretation. We developed two direct-to-patient digital interventions and evaluated association of use of these to compliance outcomes after US-wide implementation.Methods:MyZio® is an optional smartphone app (iOS&Android) for patients for use with Zio® LTCM (iRhythm Technologies, Inc; San Francisco, CA) that tracks shipping status, enables registration, provides educational content and instruction on application/activation/wear, notifies users of remaining wear time and gives return reminders. Patients with a mobile number may also opt-in to short messages services (SMS) text notifications. Opt-in patients receive texts regarding delivery, application/wear, billing information, device return and prompts to download MyZio.We evaluated patient compliance (activation, wear, and device return) in all patients shipped Zio LTCM with HE between Oct 1 and Apr 3, 2024; the period after launch of MyZio version 2.0. We calculated return rates, stratified by use of one or both digital interventions. Odds ratios were calculated and the Chi Square test was used to report associated p-values compared to the reference (no intervention).Results:The distribution of the use of digital tools and compliance outcomes in 169,131 patients are shown in Table 1. Compliance was lowest (74.6%) when both the app and text messaging were not used. App use was associated with the highest gains in compliance, largely irrespective of concomitant text messaging. Opting into SMS text was associated with compliance improvement but was inferior to app use.Conclusion:In patch-based ECG LTCM, a dedicated patient app and SMS texting were associated with improved device return rates, although the app had a stronger effect. These data support the use of patient digital health interventions in home-based diagnostics and underscore the importance of post-implementation evaluation of outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4118668-A4118668, November 12, 2024. Background:Atrial fibrillation (AF) increases risk of stroke. National guidelines recommend oral anticoagulant (OAC) use to reduce this risk. Medication adherence is pivotal for effective AF management, necessitating an understanding of adherence barriers.Aims:This mixed-methods study aimed to identify patient and provider factors influencing OAC adherence.Methods:Patients with nonvalvular AF and OAC prescriptions were sampled from a large community health system serving seven states. A stratified random sample of 2,000 patients was surveyed by mail, achieving a 13.3% response rate (266 patients). Twenty-eight semi-structured interviews were conducted with a purposive sample of patient survey respondents. Eligible providers were surveyed by email, resulting in a 3% response rate (78 providers). Survey data were analyzed descriptively and using multivariable regression models. Interview data were analyzed thematically.Results:Of 213 patients with an adherence score available, 31.5% reported non-adherence. Nonadherent patients were more likely to report poor healthcare experiences, including discrimination in a healthcare setting and poorer mental/emotional health. Receiving information from providers was significantly associated with adherence, especially among younger patients and those with fewer chronic conditions. High self-efficacy score was associated with adherence, particularly among older and rural patients. Interview analyses showed provider communication about AF medications, perceptions of AF as a serious illness, and a sense that medication was helping manage AF were all important for medication adherence. In contrast, most providers (87%) perceived high non-adherence among AF patients, citing forgetfulness, cost, and side effects as the main reasons. Providers’ responses indicate a need for improving communication and support for addressing adherence barriers.Conclusion:Most patients reported adherence to their medications, with adherence being associated with positive healthcare experiences and better mental/emotional health. Providers perceived relatively low adherence among their patients but aligned with patients on the need for improved communication and shared decision making. Tools that encourage discussion with patients and open communication between providers and patients are pivotal for optimizing patient care and enhancing medication adherence and treatment outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4148118-A4148118, November 12, 2024. Background and Objectives:Data regarding readmission rate following ICD placement in heart failure patients with Cardiac amyloidosis are scare. We attempted to study 30-day readmission rate following ICD placement in these patients and the common causes of readmission.Methods:We utilized the Nationwide Readmission Database from 2016 to 2020 and included patients more than 18 years of age who were admitted for placement of Implantable Cardiac Defibrillator (ICD) and had secondary diagnosis of heart failure and amyloidosis. We used International Classification of Disease, Tenth Revision, Clinical Modification (ICD10 CM) codes to identify patients. The primary outcome was the 30-day readmission rate, and secondary outcomes were mortality rates, and common reasons for readmission.Results:We identified a total of 457 patients who underwent placement of ICD and had heart failure with amyloidosis, among which mean age was 69 years and 25.42% were females. The 30-day readmission rate was 19.50%. Mortality rate was higher in readmitted patients (7.12%) as compared to index admission (3.82%). Most common causes of readmission were hypertension and heart failure with CKD stage 1 to 4(22%), hypertensive heart disease with heart failure (8.35%), hypertensive heart disease with CKD 5 or ESRD (7.58%), Acute Kidney Injury (5.94%), Non-specific chest pain (5.56%), Organ specific amyloidosis (5.43%), Cellulitis (3.68%), Acute on chronic systolic heart failure (3.56%), and Acute systolic heart failure (3.17%)Conclusion:The thirty-day readmission rate was 19.50% and most common cause of readmission was hypertension and heart failure with CKD. Improvement of management strategies is needed to address these causes and improve patient outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4145901-A4145901, November 12, 2024. Introduction:Current guidelines recommend preprocedural fasting for at least 6 hours for solid food and 2 hours for clear liquids before cardiac transcatheter procedures. However, the supporting data are limited.Research Question:Does non-fasting impact (NF) patient safety and comfort compared to fasting (F) in transcatheter cardiac procedures?Aims:To compare the effects of fasting vs. non-fasting on patient outcomes in cardiac transcatheter procedures.Methods:We searched the Cochrane, Embase, and Medline databases for RCTs comparing fasting versus non-fasting states for cardiac transcatheter procedures. Risk ratios (RRs) and standardized mean difference (SMD) with 95% confidence intervals (CIs) were pooled for binary and continuous outcomes, respectively, using a random-effects model. Endpoints were hunger, thirst, incidence of aspiration, nausea/vomiting, acute kidney injury (AKI), length of stay, and patient satisfaction.Results:Our meta-analysis included 8 studies with 2,930 patients. Hunger sensation was significantly lower in the NF group (SMD -0.91; 95% CI: -1.71 to -0.11; P = 0.026; I2 = 96%; Figure 1A), with no difference in thirst. The incidence of aspiration (RR 2.20; 95% CI 0.29–17.02; P = 0.449; I2 = 0%; Figure 1B), nausea/vomiting (RR 1.09; 95% CI 0.67-1.78; P = 0.723; I2 = 0%), and AKI (RR 1.90; 95% CI 0.84–4.31; P = 0.126; I2 = 0%) were not significantly different between groups. Similarly, length of stay (MD -0.01 days; 95% CI -0.39 to 0.36; P = 0.940; I2 = 3%; Figure 2A), and patient satisfaction (SMD -0.74; 95% CI: -1.54 to -0.07; P = 0.073; I2 = 98%; Figure 2B) were also similar in both groups.Conclusions:Our study suggests a non-fasting strategy is a safe option before transcatheter cardiac procedures.

Circulation, Volume 150, Issue Suppl_1, Page A4141524-A4141524, November 12, 2024. Background:Patient education is a core component of cardiac rehabilitation program and a part of the consensus statement for Cardiac rehabilitation delivery model for low resource settings. To our knowledge, there is little to no evidence regarding cardiac patient education implementation in sub–Saharan Africa, despite all the benefits and the urgent need for prevention in our settings.Purpose:To describe a patient education (PE) pilot project named “the Heart School” at Cheikh Anta Diop University of Dakar.Methods:In this cross sectional study were included 45 patients addressed for a patient education program. Patient education was delivered on weekly one-on-one sessions. Content of the educational program is shown in figure 1. Progression was assessed through self-evaluation scales with scores ranging from 0 to 10 administered before and after the program. Data analysis was performed with SPSS version 18 with a level of significance set at p

Circulation, Volume 150, Issue Suppl_1, Page ASu906-ASu906, November 12, 2024. Background:Cardiac rearrest post-return of spontaneous circulation (ROSC) is a critical concern in emergency care, as it is associated with worse outcomes. Patient characteristics and arrest factors associated with rearrest remain poorly understood, making predicting rearrest after out of hospital cardiac arrest (OHCA) challenging.Aim:To examine rearrest patterns, identify patient-specific risk factors for rearrest, and assess the impact of rearrest on patient outcomes.Hypothesis:Patients that experience rearrest after OHCA will have greater cardiac comorbidities, unfavorable arrest characteristics, and greater mortality.Methods:We performed an observational single-site clinical trial of consecutive adult EMS OHCA patients with ROSC (1/01/2018 to 3/31/24). EMS reports, continuous EMS ECG recordings, and electronic health records were analyzed to determine rearrest occurrence at any time during EMS and ED care. Patient demographics, comorbidities, and arrest/rearrest characteristics were determined. The primary outcome was survival at 6 months. Statistical significance was determined using Chi-square and logistic regression (LR) analyses.Results:We examined 344 patients with OHCA and ROSC, of whom 173 patients rearrested and 171 did not. Patients experiencing rearrest were older (p

Circulation, Volume 150, Issue Suppl_1, Page A4143615-A4143615, November 12, 2024. Background:A coronary artery calcium score of zero (CAC=0) is generally accepted as a marker of a very low 5y risk for coronary events. However, whether the prognostic value of CAC=0 varies by sex is unclear. For example, non-atherosclerotic causes of coronary ischemia present more often in women, including spontaneous coronary artery dissection and microvascular angina, which may be undetected by CAC. Further, CAC is performed at a later age in women. Whether these factors impact the utility of CAC=0 in women vs men is uncertain.Methods:We tested whether the prognostic value of CAC=0 differs by sex. We searched the Intermountain Health electronic medical record (eMR) database for patients (pts) at primary coronary risk who underwent positron emission tomography/computed tomography (PET/CT) stress testing and had a zero CAC score. We assessed coronary prognosis (i.e., coronary death [CD] or non-fatal myocardial infarction [MI]) during follow-up. Primary events were adjudicated by chart review. We compared outcomes in women vs. men. Given the small number of events, chi-square rather than time-to-event analyses were performed. We also compared all-cause death or MI rates in those with CAC=0 vs. CAC >0 by sex.Results:The eMR search identified19,495 women and 20,523 men undergoing PET/CT who were at primary coronary risk. Of these, 7967 (19.9%) had CAC=0 on CT. Of CAC=0 patients, 5400 (67.8%) were women and 2567 (32.2%) were men. Overall age averaged 60.5y (SD 12.0) in women and 53.8y (SD 12.6) in men. In total, 13 events occurred (MI=12, CD=1) over a follow-up of 2.1y (SD 1.6). By sex, 7 events (0.13%) occurred in CAC=0 women and 6 (0.24%) in men (p=0.28). Rates of all-cause death or non-fatal MI comparing CAC=0 to CAC >0 were 3.3% vs 9.5% in women and 3.3% vs 10.2% in men (both p

Circulation, Volume 150, Issue Suppl_1, Page A4147894-A4147894, November 12, 2024. Background:Patients undergoing epicardial access for ventricular tachycardia (VT) have a higher rate of complications and VT recurrence post-procedure. Data regarding electrophysiological factors driving the outcomes are scant.Objective:To compare the factors and outcomes associated with epicardial vs endocardial VT ablation.Methods:A single-center, retrospective study of patients undergoing catheter ablation for scar-related VT was conducted. Data collected included demographics, comorbidities, medications, relevant laboratory abnormalities, electrocardiograms, echocardiograms, detailed procedural characteristics, and outcomes.Results:Our cohort of 554 patients had 89 (16.1%) epicardial and 465 (83.9%) endocardial VT ablations. Patients undergoing epicardial ablation had a greater frequency of NICM, and more patients had undergone sympathetic modulation for VT (p < 0.05) but had lesser frequency of valve surgery, and CABG. Epicardial ablation was associated with greater use of both short-term (6 months) anti-arrhythmic drugs (AAD) (p

Circulation, Volume 150, Issue Suppl_1, Page A4139107-A4139107, November 12, 2024. Background:Given its chronicity and high hospitalization burden, heart failure (HF) requires close coordinated care. Health Information Exchange (HIE) systems can improve care by enabling seamless information sharing between healthcare providers and patients. We evaluated whether hospitals that have invested in more comprehensive HIE access for patients have better risk-standardized post-discharge outcomes after HF hospitalization.Methods:We defined a range of contemporary HIE services at all US acute care hospitals using the American Hospital Association (AHA) Information Technology (IT) Annual Survey (2022). HIE services included mobile access to health records, the ability to import, export, and update health records online, and the option to share patient-generated data with the health system, representing health measurements and data generated from smart devices (A). We identified each hospital’s corresponding 30-day excess days in acute care (EDAC) for HF – a risk-standardized metric of all acute care needs in the post-hospitalization period from the Centers for Medicare&Medicaid Services Quality Report (2019-2022) and examined the association between HIE services and 30-day EDAC for HF using multivariable linear regression.Results:There were 2,581 US hospitals (22% rural, 9% teaching, with a median bedsize of 162 [IQR 76, 307]) in the AHA-IT survey, with a median EDAC of 5.9 (IQR -8.6, 20.9) days for HF. The vast majority (99%) of hospitals had online health record portals, but access to specific HIE services varied widely across hospitals (B): 84% offered access via mobile application, 86% allowed data import, 55% data export to other health systems, and 77% online data updates, with fewer than half (47%) allowing patients to share patient-generated health data. After accounting for differences in hospital characteristics, only hospitals with HIE configured to enable patients to share their personal health data directly with the health system had significantly lower risk-standardized 30-day EDAC for HF (-3.9, 95% CI -1.04, -3.48) (C).Conclusions:Hospitals with HIE services that include the sharing of patient-generated data have significantly better risk-standardized post-hospitalization outcomes for HF. There is a need to evaluate the role of broader access to bidirectional data sharing as a strategy to enhance care and outcomes at hospitals treating patients with ongoing post-discharge needs.

Circulation, Volume 150, Issue Suppl_1, Page A4142863-A4142863, November 12, 2024. Introduction:Atrial fibrillation (AF) is a common arrhythmia associated with ischemic stroke. Prior work shows that stroke-reducing oral anticoagulant (OAC) therapy is less commonly prescribed in minoritized racial/ethnic groups, but the drivers of these disparities are unclear.Hypothesis:We hypothesized that clinicians and patients would provide key themes to inform disparities in OAC prescribing.Goals/Aims:To identify barriers to and facilitators of equitable OAC prescribing.Methods:Using data from a cohort of patients with incident AF in the Veterans Health Administration (VA) from 2018-2021, we identified VA medical centers (N=21) with high vs. low rates of OAC prescribing and racial disparities ( >10%) in prescribing. From these sites, we recruited 30 clinicians (PCPs, cardiologists, pharmacists) and 33 patients with AF (67% Black or Hispanic). We conducted 1:1 semi-structured interviews from 6/1/23-3/1/24. A primary and secondary analyst co-coded 20% of the interviews using negotiated consensus before coding the remaining interviews independently. Themes related to patient and structural-level barriers to and facilitators of equitable OAC use were identified using thematic analysis.Results:Clinicians identified patient-level barriers including knowledge of someone who had a negative anticoagulation experience, mistrust of the health system, and concerns about bleeding risk and side effects. Patients raised concerns about the OAC regimen or distrust of medications and a lack of information about OACs. Structural-level barriers identified by clinicians included perceptions that patients’ adverse social circumstances (e.g., homelessness) interfere with medication use, care fragmentation between VA and non-VA clinics, and AF care not being a top VA priority. Patients also identified distance to VA and poor coordination of care as barriers. All clinicians noted comfort prescribing OACs as a facilitator of equitable prescribing. Other facilitators included strong collaboration between clinicians and anticoagulation clinics, patient-clinician trust, and Veterans learning about the benefits of OAC.Conclusion:Clinicians and diverse patients with AF in VA identified several barriers to equitable prescribing of OAC, including adverse social determinants of health and care fragmentation. Strengthening physician-pharmacist collaboration, building trust with patients, and enhancing AF education are actionable strategies for eliminating disparities in OAC use.

Circulation, Volume 150, Issue Suppl_1, Page A4142117-A4142117, November 12, 2024. Introduction:The management of patients with Venous thromboembolism (VTE) receiving anticoagulant therapy is complicated by potential interactions with other medications, including antibiotics. Piperacillin-tazobactam (PTZ) has been implicated in unexpected disturbances in the coagulation cascade, which can be critical in patients concurrently using anticoagulants like rivaroxaban. This report explores the complexities of prescribing broad-spectrum antibiotics to patients with pre-existing cardiac conditions and the necessity of careful consideration of drug-drug interactions.Case Report:A 52-year-old white male with a history of deep vein thrombosis on rivaroxaban, presented with severe left leg cellulitis and subsequent gastrointestinal bleeding shortly after the initiation of piperacillin-tazobactam. His presentation was complicated by a rapid deterioration in his condition following a syncopal episode, characterized by hematochezia and hematemesis, necessitating urgent medical interventions including the cessation of all anticoagulation therapy, esophagogastroduodenoscopy and broad-spectrum antibiotics.Discussion:This case highlights the clinical challenges and potential risks of coagulopathies induced by PTZ or the interaction of PTZ with rivaroxaban, stressing the importance of multidisciplinary vigilance. The mechanisms by which PTZ may influence the coagulation pathways in patients already at risk due to their cardiac profiles underscore a significant area of concern for clinicians.

Circulation, Volume 150, Issue Suppl_1, Page A4138912-A4138912, November 12, 2024. Background:Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with heart failure with reduced ejection fraction (HFrEF) and wide QRS. Whether CRT-defibrillators (CRT-D) reduce mortality more than CRT-pacemakers (CRT-P) remains controversial.Aims:To compare the clinical outcomes of CRT-D vs CRT-P using data from 5 landmark CRT trials, both overall and stratified by etiology of cardiomyopathy (ischemic vs non-ischemic), sex (male vs female), age (≥ 70 y/o vs < 70 y/o), and QRS morphology (IVCD, LBBB, RBBB).Methods:We performed a meta-analysis of patient level data from 5 prospective CRT trials (MIRACLE, REVERSE, RAFT, COMPANION and MADIT-CRT). Inclusion criteria were CRT-P vs CRT-D status (randomized comparison only in COMPANION), age ≥ 18 y/o and LVEF ≤ 35%. Exclusion criteria included secondary prevention ICD, QRS < 120ms, pacemaker upgrade, ventricular pacing indication, or missing data. Primary outcome was composite of time to heart failure hospitalization (HFH) or all-cause death. Secondary outcomes were time to HFH and death. Outcomes were analyzed using a frequentist Cox Proportional Hazards mixed effects model adjusted for 17 variables.Results:A total of 3407 patients met inclusion criteria. Relative to patients with CRT-P (n=843), those with CRT-D (n=2564) were of similar age (66 y/o, p=0.5), less often female (24% vs 34%, p

Circulation, Volume 150, Issue Suppl_1, Page A4144833-A4144833, November 12, 2024. Introduction:The advent of Large Language Models (LLMs) such as ChatGPT and Google Gemini yields a new paradigm for patient education. Coronary artery bypass grafts (CABGs) are open-heart surgeries that naturally gives to many questions in potential patients. Prior research suggested that patient education material should be written at a 6thgrade reading level maximally to be comprehended by the majority of the US adult population. However, most education material is written at a much higher literacy level. Now with the increasing use of LLMs, the potential for informing patients at an appropriate readability level exists.Research Question:Can ChatGPT and Google Gemini improve the readability of their primary responses to patient education questions about Coronary Artery Bypass Grafts to a 6thgrade reading level?Methods:We obtained 80 questions from 4 independent participants regarding information they would want to know prior to undergoing a CABG procedure. Questions that could not be answered using public information, required clinician input, and repeats were filtered out leaving 20 questions. These questions were asked to ChatGPT 3.5 and Google Gemini. Then both LLMs were asked to answer the question at a 6thgrade level within the same conversation. A new conversation was created each of the 20 questions. All responses were then evaluated using a Flesch-Kincaid calculator where the Flesch-Kincaid reading ease score (FKRE) and the Flesch-Kincaid grade level (FKGL) were obtained. Data analysis was performed using Microsoft Excel and Graphpad Prism.Results:For the ChatGPT responses, the average FKRE was 31.865 and FKGL was 12.545. Following the 6thgrade level request for ChatGPT, the average FKRE was 74.57 (p < 0.0001) and FKGL was 5.93 (p < 0.0001). For the Google Gemini responses, the average FKRE was 46.395 and FKGL was 10.545. Following the 6thgrade level request for Google Gemini, the average FKRE was 72.945 (p < 0.0001) and FKGL was 6.76 (p < 0.0001).Conclusion:Both LLMs significantly increased the readability of their responses and did so to a 6thgrade level. However, ChatGPT was closer than Google Gemini in reaching the desired FKGL. Nonetheless, our work showed that both LLMs could successfully work with CABG information and yield responses at a readability level befitting the US population. Future studies need to assess the accuracy of this information for LLMs to have practical use in cardiac surgery patient education.

Circulation, Volume 150, Issue Suppl_1, Page ASu404-ASu404, November 12, 2024. Background:Out-of-hospital cardiac arrest (OHCA) cause significant patient morbidity and mortality. Double sequential external defibrillation (DSED) represents an alternative treatment for OHCA patients, but the use is currently reserved for patients in refractory ventricular fibrillation. However, OHCA patients may achieve return of spontaneous circulation earlier with the use of DSED as the initial treatment.Aims:To compare the necessary times needed to establish pad placement in DSED compared to standard pad placement in a live patient simulation model.Methods:This study was an observational cohort study with ambulance personnel and live patient models. Two-member teams established two defibrillators ready for rhythm analysis. Time spent for standard pad placement and DSED was registered in the same procedure. The procedure was performed on two patient categories, with BMI 20,9 (patient A) and BMI 32,8 (patient B). All team members performed the procedure on both patient categories.Results:In total, 108 procedures were performed on both patient categories. Mean difference in time needed for DSED versus standard pad placement was 13.7 ± 4.8 seconds for patient A, and 13.9 ± 4.6 seconds for patient B. There was no significant difference in time spent between the two patient categories (p=0.725).Conclusion:The necessary time to establish DSED versus standard defibrillation pad placement was short. This may support clinical studies on DSED as initial treatment for OHCA patients without risk of significant increase in time to first defibrillation.

Circulation, Volume 150, Issue Suppl_1, Page A4143017-A4143017, November 12, 2024. Background:Decentralized clinical trials using direct-to-participant recruitment can potentially engage large, representative participant pools.Research Question:Can a decentralized clinical trial use a multichannel approach to recruit patients >65 years old across the United States?Goals/Aims:To share insights on multichannel strategies for participant recruitment in the decentralized, app-based Heartline study.Methods:Heartline is a randomized trial testing the impact of a mobile app-based heart health program with the electrocardiogram (ECG) and Irregular Rhythm Notification (IRN) features on Apple Watch for early diagnosis, treatment, and outcomes of atrial fibrillation. Eligible participants were US adults aged ≥65 years with an iPhone and Medicare coverage. Multiple pathways for broad outreach were explored, including digital (eg, email, social media) and traditional channels (eg, direct mail, community outreach). Recruitment efforts were assessed and refined to reach a large eligible population.Results:A multichannel approach led to ~300,000 Heartline study app installations. In total, 34,244 participants completed enrollment (Feb 2020-Dec 2022), of whom 28,155 completed baseline demographic assessments. Participants were widely distributed geographically, with notable representation of outlying and rural areas (Figure 1). Women accounted for 54% of the participants. Overall, most participants were White (93.0%), with Asian, Black, and Hispanic participants representing 2.8%, 2.7%, and 2.5%, respectively.Conclusion:The Heartline study demonstrated the ability to recruit large numbers of participants aged ≥65 years using a direct-to-participant approach. Broad outreach strategies ensured gender and geographic diversity, enrolling a higher percentage of women than typical cardiology trials, and participation from rural areas. However, underrepresentation across racial/ethnic groups persisted and strategies to increase enrollment are needed. For similar trials, a strategic multichannel approach, with strong data and analytics capabilities may be beneficial to effectively target and enroll eligible participants.