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Background: Restricting dietary sodium is a common recommendation to address symptoms in heart failure (HF) patients. However, using the information provided on nutrition labels can be complex, leading to lapses in adherence. This problem is compounded by insufficient information on ethnic preferences in dietary habits. Based on our previous findings we developed a prototype dialogue agent (HF-DA) to assist African American (AA) and Hispanic Latino (H/L) patients with their HF self-care needs, including understanding nutrition labels and providing practical information per FDA recommendations. Objective: Compare HF-DA against existing technology in the public domain in assisting AA and H/L HF patients to make healthy food choices. Methods: We conducted a review of existing technology in two ways. 1: Google search engine: We measured the number of actions (typing, scrolling, clicking) required to find a source for a food’s sodium content matching the U.S. Department of Agriculture’s recommendations and used a calculator to understand the total sodium in a desired serving size. We identified relevant search terms by analyzing the commonly used words in the transcripts from our HF patient education sessions with their health educators (18 AA and 2 H/L) and 1:1 interviews with HF patients (3 AA and 1 H/L). 2: Google Play Store: We downloaded the top 15 apps using the search term “heart failure” and explored their functionality. Results: Google’s search engine required users to perform 1 action to identify the sodium content and percent daily value but then needed 6-8 actions (dependent on query length) to calculate sodium content of total serving size. Our HF-DA provides this information in 4 actions. Of the 15 apps available in the Play Store, none had any features for understanding nutrition labels. Conclusion: Our preliminary analysis revealed there are very few culturally sensitive technological resources available to assist HF patients in understanding nutrition labels. These resources require a patient to understand nutrition labels, perform arithmetic, and recall dietary restrictions. HF-DA is capable of promoting healthy eating habits by aiding HF patients' decision-making process by providing reliable information in fewer steps.

Comprehending medical information is a challenging task, especially for people who have not received formal medical education. When patients are discharged from the hospital, they are provided with lengthy medical documents that contain intricate terminologies. Studies have shown that if people do not understand the content of their health documents, they will neither look for new information regarding their illness nor will they take actions to prevent or recover from their health issue. In this article, we highlight the need for generating personalized hospital-stay summaries and several research challenges associated with this task. The proposed directions are directly informed by our ongoing work in generating concise and comprehensible hospitalization summaries that are tailored to suit the patient’s understanding of medical terminologies and level of engagement in improving their own health. Our preliminary evaluation shows that our summaries effectively present required medical concepts.

Introduction Heart failure (HF) is a public health problem, and self-care remains poor, especially among minorities. Access to personalized educational material via an interactive dialogue agent (DA), a system intended to converse with humans in natural language, has the potential to improve self-care. This abstract outlines the initial steps of developing an artificial intelligence-based DA to assist African American (AA) and Hispanic/Latino (H/L) HF patients with their self-care needs. Hypothesis Analysis of HF education sessions between health educators (HE) and patients can provide insight into the topics that AA and H/L patients value. Method In this IRB approved pilot study, we have recorded, transcribed, and verified 20 (18 AA and 2 H/L) HF education sessions between HE and HF patients. Latent Dirichlet Allocation (LDA), a topic modeling algorithm and Empath, a text analysis tool were used to identify common discussion topics in the transcripts. An initiative analysis was performed to identify conversation drivers where each turn (unit of speech by a single speaker, without interruption from the other speaker) was classified as either a question (ending with ‘?’), a prompt (having only filler words like umm, okay) or an assertion/command (others). Lastly, we compared the transcripts against a HF ontology published by the National Center for Biomedical Ontology and the Consumer Health Vocabulary (CHV) available in the Unified Medical Language System (UMLS) to identify the term overlap. Results On average, HE took 117 turns comprising 205 sentences and 2281 words per conversation, whereas patients took 108 turns comprising 131 sentences and 850 words. Per conversation, HE asked 26 questions and had 17 prompts as opposed to 3 questions and 39 prompts by the patients. LDA identified HF and heart function, effects of HF, low salt diet, and follow-up appointment and medication as the top 4 most common topics discussed by the HE. When looking at the entire transcripts, Empath identified eating, health, and cooking as the most common topics for both the HE and the patients. Patients frequently discussed children and family, whereas HE focused on providing HF information as indicated by LDA. Lastly, only 2.1% of HE terms overlapped with the HF ontology. Our analysis revealed that 25% and 22% of the terms (without stop words such as at, the) used by the patients and HE respectively match with the ‘preferred label’ in the CHV. For both, the high frequency terms included heart, heart failure, salt, water, and fluid. This also correlated with our topic analysis findings from Empath and LDA. Conclusion Our analysis helps triangulate the kind of information HE and HF patients value. Though mostly HE dominated the conversation, it is essential to incorporate the topics that patients brought up into the DA and use culturally sensitive vocabulary while communicating them. Next, we will collect more recordings, conduct focus groups, and evaluate the usability of our prototype DA.

Heart failure is a global epidemic with debilitating effects. People with heart failure need to actively participate in home self-care regimens to maintain good health. However, these regimens are not as effective as they could be and are influenced by a variety of factors. Patients from minority communities like African American (AA) and Hispanic/Latino (H/L), often have poor outcomes compared to the average Caucasian population. In this paper, we lay the groundwork to develop an interactive dialogue agent that can assist AA and H/L patients in a culturally sensitive and linguistically accurate manner with their heart health care needs. This will be achieved by extracting relevant educational concepts from the interactions between health educators and patients. Thus far we have recorded and transcribed 20 such interactions. In this paper, we describe our data collection process, thematic and initiative analysis of the interactions, and outline our future steps.

BACKGROUND A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin. OBJECTIVE This study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial. METHODS Potential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants’ blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants’ group membership. The primary outcome was a feasibility analysis of recruitment and retention. RESULTS The mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients’ reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found. CONCLUSIONS Elderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education.

Background Patient populations with low socioeconomic status (SES) experience psychological stress because of social determinants of health. Social determinants of health contribute to self-care-especially among patients with heart failure (HF). Objective We sought to describe the influence of stress and social determinants of health on self-care in patients with HF who have low SES. Methods In this mixed-methods, concurrent embedded study, participants (N = 35) were recruited from 2 urban hospitals in Chicago if they had low SES and were readmitted within 120 days of an exacerbation of HF. We conducted semistructured interviews to collect qualitative data about stressors associated with patients' living circumstances, strategies patients used to foster self-care, family dynamics, and coping strategies patients used to decrease stress. We measured psychological stress (Perceived Stress Scale [PSS-10]), and self-care (Self-care of Heart Failure Index). Content analysis was used to analyze the qualitative data, and descriptive statistics were used to describe the sample. In the final analytic phase, the qualitative and quantitative data were integrated. Results Self-care was poor: 91.5% of participants had Self-care of Heart Failure Index subscale scores lower than 70. Perceived stress was high: 34% of participants had PSS-10 scores of 20 or higher. Several social determinants of health emerged as affecting self-care: financial stress, family personal health, past impactful deaths, and a recent stressful event (eg, child's death). Participants lived in areas with high crime and violence, and participants described many stressful events. However, among participants whose PSS-10 scores were lower than 20 (indicating lower stress), there was discordance among the description of factors impacting self-care and their PSS-10 score. Conclusions Social determinants of health negatively impact the ability of low-SES patients to manage their HF symptoms and adhere to a medication and dietary regimen. It is important that healthcare providers assess patients' stressors so appropriate referral to services can occur.

Previous work indicates the potential for community health workers and peer coaches serving as patient navigators to improve processes of care and health outcomes during care transitions, but have not been sufficiently tested to determine if such programs improve measures of patient experience in minority serving institutions. The objectives of the Patient Navigator to Reduce Readmissions (PArTNER) study was to: 1) conduct a pragmatic clinical effectiveness trial comparing a multi-faceted, stakeholder-supported Navigator intervention (in-person CHW visits in the hospital and after hospital discharge, plus telephone-based peer coaching) versus usual care on the experience of hospital-to-home care transitions in patients hospitalized with heart failure, pneumonia, chronic obstructive pulmonary disease, myocardial infarction, or sickle cell disease; 2) examine the effectiveness of the Navigator intervention in patient subgroups; and 3) understand the barriers and facilitators of successfully implementing the Navigator intervention across patient populations. The co-primary outcomes are the 30-day changes in: 1) Patient Reported Outcomes Measurement Information System (PROMIS) emotional distress-anxiety, and 2) PROMIS informational support. Secondary outcomes at 30 and 60 days include other PROMIS health measures and hospital readmissions. Innovative features of the PArTNER study include early and continuous engagement of patients, their caregivers, clinicians, health system administrators, and other stakeholders to inform the design and implementation of the Navigator intervention. In this report, we describe the design of the PArTNER study. Keywords: Pragmatic clinical trial, Hospital-to-home transition, Hospital readmissions, Community health worker, Peer coaching

A patient with complex needs returns to the hospital again and again, despite his care team's efforts to reduce readmissions.

Background A lifesaving treatment for myocardial infarction is the placement of a stent in a closed or obstructed coronary artery. The largest modifiable risk factor after receiving a stent is medication adherence to Dual AntiPlatelet Therapy, a combination of P2Y12 inhibitors and aspirin. Objective This study aimed to determine the acceptability of a protocol and an intervention using the My Interventional Drug-Eluting Stent Educational App (MyIDEA) and to evaluate medication adherence using the proportion of days covered (PDC) and platelet activation tests in a multisite randomized controlled trial. Methods Potential participants who received a post percutaneous coronary intervention (PCI) procedure with a drug-eluting stent were approached. All patients older than 50 years and who spoke English were recruited. Participants were recruited, baseline demographics were collected, and the Hospital Anxiety and Depression Scale (HADS), Rapid Estimate of Adult Literacy in Medicine-Short Form, Burden-Benefit questionnaire, 36-Item Short Form Health Survey, and PCI knowledge questionnaire were administered. Block randomization was used to randomize participants to either usual care or MyIDEA supplementation. MyIDEA is a personalized educational intervention based on the Kolb experiential learning theory using patient narratives for education. During the visits, participants’ blood was collected to measure platelet suppression from medication. During the second and third encounters, the Morisky medication adherence score and cardiology outcomes were measured. The study was conducted at the University of Illinois Hospital and John H Stroger Jr Cook County Hospital with appropriate ethical approvals. Platelet suppression was measured through aspirin reactive units and P2Y12 reactive units. Medication adherence was measured using the PDC. The analysis team was blinded to the participants’ group membership. The primary outcome was a feasibility analysis of recruitment and retention. Results The mean age of participants was 60.4 years (SD 7.1); the majority of patients were black and non-Hispanic. The majority of patients’ reading levels were seventh grade or above, and they were not very familiar with other electronic devices for information and communication. The number of control subjects was 21, and the number of participants in the interventional arm was 24. The interventional group was able to use MyIDEA in both the hospital and outpatient setting. However, there was no significant difference in platelet suppression or medication adherence between groups. There were also differences between the groups in terms of depression and anxiety, initially, as measured by HADS. No documented adverse event associated with the intervention was found. Conclusions Elderly patients are willing to use tablet devices to be educated about health conditions. Additional studies are required to measure the effectiveness and determine the most suitable timing and location for patient education. Trial Registration ClinicalTrials.gov NCT04439864; https://clinicaltrials.gov/ct2/show/NCT04439864

Most of the health documents, including patient education materials and discharge notes, are usually flooded with medical jargons and contain a lot of generic information about the health issue. In addition, patients are only provided with the doctor’s perspective of what happened to them in the hospital while the care procedure performed by nurses during their entire hospital stay is nowhere included. The main focus of this research is to generate personalized hospital-stay summaries for patients by combining information from physician discharge notes and nursing plan of care. It uses a metric to identify medical concepts that are Complex, extracts definitions for the concept from three external knowledge sources, and provides the simplest definition to the patient. It also takes various features of the patient into account, like their concerns and strengths, ability to understand basic health information, level of engagement in taking care of their health, and familiarity with the health issue and personalizes the content of the summaries accordingly. Our evaluation showed that the summaries contain 80% of the medical concepts that are considered as being important by both doctor and nurses. Three patient advisors (i.e. individuals who are trained in understanding patient experience extensively) verified the usability of our summaries and mentioned that they would like to get such summaries when they are discharged from hospital.

Background/aims This study’s objective was to evaluate a patient-centered educational electronic tablet application, “My Interventional Drug-Eluting Stent Educational App” (MyIDEA) to see if there was an increase in patient knowledge about dual antiplatelet therapy (DAPT) and medication possession ratio (MPR) compared to treatment as usual. Methods In a pilot project, 24 elderly (≥50 years old) research participants were recruited after a drug-eluting stent. Eleven were randomized to the control arm and 13 to the interventional arm. All the participants completed psychological and knowledge questionnaires. Adherence was assessed through MPR, which was calculated at 3 months for all participants who were scheduled for second and third follow-up visits. Results Relative to control, the interventional group had a 10% average increase in MPR. As compared to the interventional group, more patients in the control group had poor adherence (

Background: More than 80% of patients presenting to the emergency department (ED) with acute decompensated heart failure (ADHF) are admitted and categorized as either observation (OBS) or inpatient (IP) post discharge using Interqual criteria (severity of illness and intensity of service). Identifying patient characteristics upon admission to determine OBS or IP status may optimize hospital resource utilization. Purpose: To determine patient characteristics upon admission that are associated with the categorization (OBS vs IP) for patients with ADHF presenting to the ED of an urban academic medical center. Methods: Retrospective medical record review of 172 randomly selected adult patients from 2013 who presented to the ED with ADHF. Patients had been categorized as OBS vs IP after discharge based on Interqual Criteria. Based on the literature, we identified variables traditionally associated with an admitting diagnosis for heart failure (HF) including: symptoms (shortness of breath, paroxysmal nocturnal dyspnea, orthopnea, and lower extremity edema), physiologic measures (B-type natriuretic peptide and blood pressure), and patient characteristics (number of co-morbidities, type of HF- HF with reduced ejection fraction vs HF with preserved ejection fraction, 30 day readmission rate, gender, ethnicity, and history of substance abuse within the past 12 months). Chi square tests and student t-tests were used to compare variables between groups. Results: Of the 172 ADHF patients, 76% (n=131) were categorized as IP and 24% (n=41) were OBS. The majority of patients were African American (n = 130, 75.6%), female (n = 101, 58.7%) and had HF with a reduced ejection fraction (n = 99, 57.6%). There were no significant differences between the OBS and IP groups in terms of symptoms, B-type natriuretic peptide levels, blood pressure, number of co-morbidities, type of HF, 30 day readmission rate, gender, ethnicity, or socio-demographic characteristics. A history of substance abuse was more common among the OBS group versus the IP group ( p = 0.013). Conclusions: In this single center retrospective medical record review comparing the categorization of patients presenting to the ED with ADHF as OBS vs IP, we found no difference in the traditional clinical variables between groups. However, a history of substance abuse was associated with the patient being categorized as OBS. Substance abuse may be an important non-traditional variable to consider in resource utilization.

Introduction Patients with low socioeconomic status (SES) have worse heart failure (HF) outcomes than patients with high SES, including higher readmissions. Interventions to improve outcomes in low SES patient populations have not been successful however the reasons remain unclear. Objective To describe the social factors impacting psychological stress and self-care in a low SES patient population with HF and multiple readmissions. Methods In this mixed methods study, 35 subjects with low SES participated in semi-structured interviews about personal and community factors impacting their stress and self-care. Subjects were interviewed during an inpatient readmission for acute decompensated heart failure from two urban hospitals in Chicago. Subjects completed standardized instruments measuring psychological stress (PSS-10), and self-care (SCHFI). Subjects were categorized into high stress (PSS-10 >20) and moderate/low stress (PSS-10 Results Ninety one percent of subjects were African American and 91% were from neighborhoods with high rates of poverty and violence according to US Census data. Subjects experienced a range of admissions (2–12) within the previous 180 days of the current HF admission. Across all three SCHFI sub-scales, the majority of scores were 20 (PSS-10 (14.9 [8.2]). The overarching qualitative theme was that social factors and psychological stress influence self-care. Subjects described the following events as stressful and impacting their self-care: financial difficulties, concern for children/grandchildren's safety, personal health, past impactful deaths, and a recent stressful event. Among subjects whose PSS-10 scores were Conclusion Social factors and psychological stress has impacted the ability of this low SES patient population to perform adequate HF self-care. Research to develop and test sensitive interventions that address social determinants influencing self-care are needed since low SES patient populations continue to experience poorer outcomes.

Background: Anemia is a frequently encountered comorbidity that affects both death and hospitalization in patients with heart failure (HF). The effect of anemia on 30-day hospital readmission in African Americans (AA) with HF has not been studied. Methods: We retrospectively enrolled all 243 (61% female) self-reported AA adults admitted to the University of Illinois at Chicago hospital with the diagnosis of HF from January 2011 to December 2012. Extensive medical chart reviews were performed. Results: The prevalence of anemia with hemoglobin (Hb) Conclusion: Lower Hb levels are associated with higher 30-day readmission rates in hospitalized AA patients with HF. Interventions towards appropriate treatment and prevention of anemia in AA with HF might reduce their readmission rates and improve their outcome.

Background The Northwestern University Center for Education and Research on Therapeutics (CERT), funded by the Agency for Healthcare Research and Quality, is one of seven such centers in the USA. The thematic focus of the Northwestern CERT is ‘Tools for Optimizing Medication Safety.’ Ensuring drug safety is essential, as many adults struggle to take medications, with estimates indicating that only half of adults take drugs as prescribed. This report describes the methods and rationale for one innovative project within the CERT: the ‘Primary Care, Electronic Health Record-Based Strategy to Promote Safe and Appropriate Drug Use’. Methods/Design The overall objective of this 5-year study is to evaluate a health literacy-informed, electronic health record-based strategy for promoting safe and effective prescription medication use in a primary care setting. A total of 600 English and Spanish-speaking patients with diabetes will be consecutively recruited to participate in the study. Patients will be randomized to receive either usual care or the intervention; those in the intervention arm will receive a set of print materials designed to support medication use and prompt provider counseling and medication reconciliation. Participants will be interviewed in person after their index clinic visit and again one month later. Process outcomes related to intervention delivery will be recorded. A medical chart review will be performed at 6 months. Patient outcome measures include medication understanding, adherence and clinical measures (hemoglobin A1c, blood pressure, and cholesterol; exploratory outcomes only). Discussion Through this study, we will be able to examine the impact of a health literacy-informed, electronic health record-based strategy on medication understanding and adherence among diabetic primary care patients. The measurement of process outcomes will help inform how the strategy might ultimately be refined and disseminated to other sites. Strategies such as these are needed to address the multifaceted challenges related to medication self-management among patients with chronic conditions. Trial registration Clinicaltrials.gov NCT01669473.

Patient education and effective communication are core elements of the nursing profession; therefore, awareness of a patient's health literacy is integral to patient care, safety, education, and counseling. Several past studies have suggested that health care providers overestimate their patient's health literacy. In this study, the authors compare inpatient nurses' estimate of their patient's health literacy to the patient's health literacy using Newest Vital Sign as the health literacy measurement. A total of 65 patients and 30 nurses were enrolled in this trial. The results demonstrate that nurses incorrectly identify patients with low health literacy. In addition, overestimates outnumber underestimates 6 to 1. The results reinforce previous evidence that health care providers overestimate a patient's health literacy. The overestimation of a patient's health literacy by nursing personnel may contribute to the widespread problem of poor health outcomes and hospital readmission rates.

Health literacy refers to a patient's knowledge and skill in making informed health care decisions. Low health literacy is associated with poor health outcomes that nurses have the potential to affect. Screening tools are available to assess a patient's health literacy, but not all are easy to use. Recently health literacy experts have recommended that all patients be treated as if they have low health literacy. The authors review the recent definitions and dimensions of health literacy, the prevalence and characteristics of patients with low health literacy, and strategies nurses can use in clinical settings.

Introduction End stage liver disease (ESLD) is a highly morbid condition. While awaiting liver transplantation, many patients experience adverse events including cardiovascular events. Performing invasive cardiac procedures is a precarious undertaking given abnormal bleeding profiles that are common in this patient population. Revascularization options are challenging due to a need a potentially life changing operation, inability to tolerate dual antiplatelet therapy, and other comorbidities. Objective To examine the characteristics and outcomes of patients who are awaiting a liver transplant with ESLD who undergo cardiac catheterization at a University Medical Center. Methods We reviewed the medical records of all patients awaiting liver transplantation that were referred for cardiac catheterization between March 2006 and December 2010. We recorded demographic data, cardiac risk factors, relevant laboratories, results of their catheterization procedure and adverse events for the following year. Death from any cause within one year of the procedure, myocardial infarction, stroke, repeat revascularization, cardiac re-hospitalization and periprocedural bleeding were recorded as adverse events. Only patients with complete follow-up records were included. The MELD score, a common measurement of liver disease severity, was calculated at the time of initial referral Results Of the 440 charts reviewed, 18% (78) patients had a left heart catheterization. The demographics of the patients who had a left heart catheterization were women 35% (n=28), 50% (39) Caucasian, 21% (16) Black, 23% (18) Hispanic and 6% other. The average MELD score at the time of the procedure was 17, with the average platelet count 101. Cardiac risk factors were diabetes 59% (46), hyperlipidemia 13% (10) and hypertension. 30% (23) had radial access, while 70% (55) had femoral. 14% (n=11) underwent revascularization (7 PCI and 4 CABG). Complications for all patients undergoing cardiac catheterization included bleeding 26% (20) and death within one year 28% (22). Conclusion Patient with ESLD undergoing a cardiac catheterization have a higher rate of bleeding complications and death than patients who don’t have ESLD (26% versus

To the Editor: In 2009, the Centers for Medicare and Medicaid Services began reporting publicly 30-day readmission rates for acute decompensated heart failure in an effort to highlight preventable readmissions, improve care, and control costs. This decision was based, in part, on recent observations of elderly Medicare fee-for-service beneficiaries that found a median readmission rate of 24.4% (range, 15.9% to 34.4%).1 A follow-up study by Ross et al2 published in Circulation: Heart Failure evaluated trends in readmission after acute decompensated heart failure hospitalization and found similar readmission rates (23.7% to 23.9%) over the 3-year period from 2004 to 2006. Both of these …

BackgroundPatient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, “My Interventional Drug-Eluting Stent Educational App (MyIDEA).” This is an educational program designed to improve patient medication adherence. ObjectiveOur goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent. MethodsPatient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers’ suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible. ResultsThe MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session. ConclusionsIncluding patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success.

Patients with chronic conditions like heart failure are the most likely to be re-hospitalized. One step towards avoiding re-hospitalization is to devise strategies for motivating patients to take care of their own health. In this paper, we perform a quantitative analysis of patients’ narratives of their experience with heart failure and explore the different topics that patients talk about. We compare two different groups of patients- those unable to take charge of their illness, and those who make efforts to improve their health. We will use the findings from our analysis to refine and personalize the summaries of hospitalizations that our system automatically generates.

Background The goal of this study was to determine if left ventricular (LV) global longitudinal strain (GLS) predicts heart failure (HF) readmission in patients with acute decompensated heart failure. Methods and results Two hundred ninety one patients were enrolled at the time of admission for acute decompensated heart failure between January 2011 and September 2013. Left ventricle global longitudinal strain (LV GLS) by velocity vector imaging averaged from 2, 3 and 4-chamber views could be assessed in 204 out of 291 (70%) patients. Mean age was 63.8 ± 15.2 years, 42% of the patients were males and 78% were African American or Hispanic. Patients were followed until the first HF hospital readmission up to 44 months. Patients were grouped into quartiles on the basis of LV GLS. Kaplan-Meier curves showed significantly higher readmission rates in patients with worse LV GLS (log-rank p

Background Despite increasing clinical use, there is limited data regarding regadenoson in stress perfusion cardiovascular magnetic resonance (CMR). In particular, given its long half-life the optimal stress protocol remains unclear. Although Myocardial Perfusion Reserve (MPR) may provide additive prognostic information, current techniques for its measurement are cumbersome and challenging for routine clinical practice. The aims of this study were: 1) To determine the feasibility of MPR quantification during regadenoson stress CMR by measurement of Coronary Sinus (CS) flow; and 2) to investigate the role of aminophylline reversal during regadenoson stress-CMR. Methods 117 consecutive patients with possible myocardial ischemia were prospectively enrolled. Perfusion imaging was performed at 1 minute and 15 minutes after administration of 0.4 mg regadenoson. A subgroup of 41 patients was given aminophylline (100 mg) after stress images were acquired. CS flow was measured using phase-contrast imaging at baseline (pre CS flow), and immediately after the stress (peak CS flow) and rest (post CS flow) perfusion images. Results CS flow measurements were obtained in 92% of patients with no adverse events. MPR was significantly underestimated when calculated as peak CS flow/post CS flow as compared to peak CS flow/pre CS flow (2.43 ± 0.20 vs. 3.28 ± 0.32, p = 0.03). This difference was abolished when aminophylline was administered (3.35 ± 0.44 vs. 3.30 ± 0.52, p = 0.95). Impaired MPR (peak CS flow/pre CS flow

Background Measurement of myocardial perfusion reserve (MPR) can potentially extend the scope of conventional myocardial perfusion imaging from detection of flow limiting epicardial stenosis to assessment of coronary microvascular function. Recent studies have suggested that MPR may improve risk stratification of patients with known or suspected CAD. MPR has traditionally been measured using PET or CMR time-intensity curves. However, these techniques are cumbersome, require radiation (for PET) and are not practical for routine clinical practice. Measurement of coronary sinus (CS) flow with phase-contrast MRI is an alternative, simple method for assessing MPR. The aim of this study was to identify the clinical determinants of MPR using this method in patients with symptoms of possible myocardial ischemia presenting for CMR stress testing.