Search

Background: Physician communication of lifetime risk prediction can improve patient understanding of atrial fibrillation (AF) risk and motivate lifestyle changes and preventive measures. Therefore, our objective was to assess how physicians perceive short-term and lifetime risks of atrial fibrillation (AF), using a survey. Methods: We invited American Heart Association (AHA) members to complete an online survey via email from November 2-22, 2021. Respondents were randomized to one of 32 vignettes characterized by AF risk factors (height, weight, current smoking, systolic blood pressure, diastolic blood pressure, use of antihypertensive medication, diabetes, history of heart failure, and history of myocardial infarction). Respondents were further randomized to either estimate the 5-year or lifetime AF risk on a 0-100% scale with 10% intervals (e.g., “10-19%”) or were shown the predicted 5-year or lifetime AF risk value and asked to pick the correct interpretation in a multiple-choice question. Results: Of 11,330 AHA professional members who received the emailed survey, 109 (1%) physicians responded (mean age 51 years, 33% women) (Table). Most respondents estimated the 5-year AF risk correctly (7/9, 78%) but none accurately estimated the lifetime risk (0/18, 0%). Most respondents interpreted the predicted 5-year risk correctly (21/28, 75%) but about half of respondents misinterpreted the lifetime risk (14/25, 56%). Conclusions: In a small sample of physicians, few respondents correctly estimated and interpreted the lifetime risk of AF, suggesting that physicians may not be familiar with this risk format. It may be necessary to study the frequency and manner in which physicians communicate lifetime risk of AF.

Atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI) and vice versa. This bidirectional association relies on shared risk factors as well as on several direct and indirect mechanisms, including inflammation, atrial ischaemia, left ventricular remodelling, myocardial oxygen supply–demand mismatch and coronary artery embolism, through which one condition can predispose to the other. Patients with both AF and MI are at greater risk of stroke, heart failure and death than patients with only one of the conditions. In this Review, we describe the bidirectional association between AF and MI. We discuss the pathogenic basis of this bidirectional relationship, describe the risk of adverse outcomes when the two conditions coexist, and review current data and guidelines on the prevention and management of both conditions. We also identify important gaps in the literature and propose directions for future research on the bidirectional association between AF and MI. The Review also features a summary of methodological approaches for the study of bidirectional associations in population-based studies.

Aims Heart failure with preserved ejection fraction (HFpEF) is a rapidly growing global health problem. To date, diagnosis of HFpEF is based on clinical, invasive, and laboratory examinations. Electrocardiographic findings may vary, and there are no known typical ECG features for HFpEF. Methods and results This study included two patient cohorts. In the derivation cohort, we included n = 1884 patients who presented with exertional dyspnoea or equivalent and preserved ejection fraction (≥50%) and clinical suspicion for coronary artery disease. The ECGs were divided in segments, yielding a total of 77 558 samples. We trained a convolutional neural network (CNN) to classify HFpEF and control patients according to European Society of Cardiology (ESC) criteria. An external group of 203 volunteers in a prospective heart failure screening programme served as a validation cohort of the CNN. The external validation of the CNN yielded an area under the curve of 0.80 [95% confidence interval (CI) 0.74–0.86] for detection of HFpEF according to ESC criteria, with a sensitivity of 0.99 (95% CI 0.98–0.99) and a specificity of 0.60 (95% CI 0.56–0.64), with a positive predictive value of 0.68 (95%CI 0.64–0.72) and a negative predictive value of 0.98 (95% CI 0.95–0.99). Conclusion In this study, we report the first deep learning-enabled CNN for identifying patients with HFpEF according to ESC criteria including NT-proBNP measurements in the diagnostic algorithm among patients at risk. The suitability of the CNN was validated on an external validation cohort of patients at risk for developing heart failure, showing a convincing screening performance.

Background Left atrial volume (LAV) and low voltage areas (LVAs) are acknowledged markers for worse rhythm outcome after ablation of atrial fibrillation (AF). Some studies reported the importance of increased right atrial volume (RAV) as a predictor for arrhythmia recurrences in AF patients. Objective To investigate association between the LAV/RAV ratio and LVAs presence. Methods Patients undergoing first AF ablation were included. LVAs were assessed peri‐procedurally using high‐density 3D maps and defined as RAV. In univariable analysis LAV > RAV was associated with LVAs (OR 6.803, 95%CI 1.395–26.514, p = .016). The association remained robust in multivariable model after adjustment for persistent AF, CHA2DS2‐VASc score, and heart rate (OR 5.981, 95%CI 1.256–28.484, p = .025). Using receiver operator curve analysis, LAV > RAV (AUC 0.668, 95%CI 0.585–0.751, p = .001) was significant predictor for LVAs. In multivariable analysis, after adjustment for age, persistent AF, and renal function, RAV≥LAV was threefold higher in males (OR 3.040, 95%CI 1.050–8.802, p = .04). Conclusions LAV > RAV is useful for the prediction of electro‐anatomical substrate in AF. LAV > RAV was associated with LVAs presence, while male sex remained associated with RAV≥LAV and less LVAs.

Background: The aim of the current study was to analyze the impact of single versus double transseptal puncture (TSP) for atrial fibrillation (AF) ablation. Methods: Consecutive patients undergoing AF ablation were prospectively included in the AF ablation registry and were analyzed according to single versus double TSP. Results: A total of 478 patients (female 35%, persistent AF 67%) undergoing AF ablation between 01/2014 and 09/2014 were included. Single TSP was performed in 202 (42%) patients, double TSP in 276 (58%) patients. Age, gender, body mass index, CHA2DS2-VASc score, left ventricular ejection fraction and operator experience (experienced operator defined as ≥ 5 years of experience in invasive electrophysiology) were equally distributed between the two groups. Repeat procedures (re-dos) were more frequently performed using single TSP access (p < 0.001). Left atrial (LA) diameter was larger in patients with double TSP (p = 0.001). Procedure duration in single TSP was identical to double TSP procedures (p = 0.823). Radiation duration was similar between the two groups (p = 0.217). There were 49 (10%) patients with complications after catheter ablation. There were no differences between complication rates and TSP type (p = 0.555). Similarly, recurrence rates were comparable between both TSP groups (p = 0.788). Conclusions: There was no clear benefit of single or double TSP in AF ablation.

High-density lipoprotein (HDL), best known for cholesterol transport, also has anti-inflammatory effects. Previous studies suggest involvement of myeloperoxidase (MPO) in modification of HDL. HDL bound Sphingosine-1-phosphate (S1P) has been implied to be an essential protein regarding beneficial HDL effects. In this study, we analyzed anti-inflammatory HDL properties in patients with atrial fibrillation (AF), a disease involving atrial inflammation, compared to non-AF controls and whether anti-inflammatory properties improve upon catheter ablation. Additionally, association with serum concentrations of MPO and S1P were assessed. We isolated HDL from 25 AF patients, 13 non-AF individuals and 14 AF patients at follow-up (FU) after catheter ablation. S1P was measured in a cohort of 141 AF and 21 FU patients. Following preincubation with HDL from either group, bovine aortic endothelial cells were stimulated using tumor necrosis factor α and expression of pro-inflammatory genes intercellular adhesion molecule 1 (ICAM1), vascular cell adhesion molecule 1 (VCAM1), E-selectin (SELE) and P-selectin (SELP) was assessed using qPCR. Concentrations of circulating protein of these genes as well as MPO and S1P were measured in serum samples. Compared to non-AF individuals HDL from AF patients suppressed gene expression of the pro-inflammatory adhesion molecules ICAM1, VCAM1, SELE and SELP 27%, 18%, 21% and 57% less, respectively (p p = 0.06). In FU patients, the anti-inflammatory HDL activity was improved (suppression of ICAM1 + 22%, VCAM1 + 10%, SELE + 38% and SELP + 75%, p p = 0.08). AF patients using angiotensin converting enzyme inhibitors or angiotensin receptor blockers had better anti-inflammatory HDL properties than non-users (gene expression suppression at least 28% more, p p = 0.051). Circulating protein concentrations were not correlated with in vitro gene-expression, but circulating P-selectin was generally elevated in AF and FU patients compared to non-AF patients. MPO plasma concentration was positively associated with gene-expression of ICAM1, VCAM1 and SELP (r2 > 0.4, p p

Recent studies have reported an association between N-terminal atrial natriuretic peptide (NT-proANP) and the progression of atrial fibrillation (AF). However, NT-proANP levels in peripheral and cardiac circulation in AF patients and in non-AF individuals need to be defined. The aims of the current study are (1) to analyze NT-proANP levels in peripheral and cardiac circulation in AF patients and (2) to compare NT-proANP levels in individuals with and without AF. We recruited AF patients who were undergoing their first AF catheter ablation and non-AF individuals. Blood plasma samples taken from the femoral vein and the left atrium (LA) were collected before AF ablation in the AF patients and from the cubital vein in the non-AF controls. Low voltage areas (LVAs) were determined using high-density maps during catheter ablation and defined as

Subjective estimation of recurrence after atrial fibrillation ablation is an important tool in clinical use. The aim of this study is to evaluate (1) if the subjective complexity of an atrial fibrillation ablation procedure is correlated with rhythm stability and (2) if the subjective prognosis of the operator has a predictive value. We prospectively enrolled patients admitted for ablation of atrial fibrillation. Two scores were given immediately after the procedure by the operator: the complexity and the prognosis scores. With routine follow-ups, we tried to evaluate the correlation between the subjective scores and measured outcome. The study population included 611 patients (63 ± 10 years, 37% females, 61% persistent AF). During follow-up (FU) (median 24, IQR 7–36 months), recurrences occurred in 44% patients. Both scores (prognosis and complexity) correlated significantly with age, persistent AF, LA diameter, procedural characteristics, and recurrences. On multivariable analysis, complexity (OR 1.304, 95%CI 1.016–1.675, p = 0.037) and prognosis (OR 1.443, 95%CI 1.080–1.982, p = 0.013) scores remained significant predictors for arrhythmia recurrences. On ROC analysis, both scores showed significant predictive value for rhythm outcomes after catheter ablation (AUC 0.599 and 0.613, both p

Abstract Arginine, homoarginine (hArg), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA) affect nitric oxide metabolism and altered concentrations are associated with cardiovascular morbidity and mortality. We analyzed these metabolites using liquid chromatography–tandem mass spectrometry in patients with atrial fibrillation (AF) (n = 241) with a focus on heart rhythm at blood withdrawal, AF progression phenotypes, and successful sinus rhythm (SR) restoration (n = 22). AF progression phenotypes were defined as paroxysmal AF with/without low voltage areas (LVA) and persistent AF with/without LVA. While arginine, ADMA, and hArg were within reference limits for healthy controls, SDMA was higher in the AF cohort (0.57 ± 0.12 vs. 0.53 μmol/L (97.5th percentile in reference cohort)). SR restoration in AF patients resulted in normalization of SDMA concentrations (0.465 ± 0.082 vs. 0.570 ± 0.134 μmol/L at baseline, p p = 0.006) and higher ADMA concentrations (0.526 ± 0.08 vs. 0.477 ± 0.08 μmol/L, p p = 0.046)) independent of heart rhythm at blood sampling. Summarizing, arginine metabolism imbalance is associated with AF in general and AF progression and may contribute to associated risk. Key messages • Heart rhythm at blood withdrawal affects ADMA and hArg level in AF patients. • SDMA is higher in AF patients. • SDMA levels normalize after sinus rhythm restoration. • hArg levels decrease in advanced AF progression phenotypes.

BackgroundThe heartbeat-evoked potential (HEP) is a brain response to each heartbeat, which is thought to reflect cardiac signaling to central autonomic areas and suggested to be a marker of internal body awareness (e.g., interoception).ObjectivesBecause cardiac communication with central autonomic circuits has been shown to be impaired in patients with atrial fibrillation (AF), we hypothesized that HEPs are attenuated in these patients.MethodsBy simultaneous electroencephalography and electrocardiography recordings, HEP was investigated in 56 individuals with persistent AF and 56 control subjects matched for age, sex, and body mass index.ResultsHEP in control subjects was characterized by right frontotemporal negativity peaking around 300 to 550 ms after the R-peak, consistent with previous studies. In comparison with control subjects, HEP amplitudes were attenuated, and HEP amplitude differences remained significant when matching the samples for heart frequency, stroke volume (assessed by echocardiography), systolic blood pressure, and the amplitude of the T-wave. Effect sizes for the group differences were medium to large (Cohen’s d between 0.6 and 0.9). EEG source analysis on HEP amplitude differences pointed to a neural representation within the right insular cortex, an area known as a hub for central autonomic control.ConclusionsThe heartbeat-evoked potential is reduced in AF, particularly in the right insula. We speculate that the attenuated HEP in AF may be a marker of impaired heart–brain interactions. Attenuated interoception might furthermore underlie the frequent occurrence of silent AF.

Background The electronic Framingham Heart Study (eFHS) is an ongoing nested study, which includes FHS study participants, examining associations between health data from mobile devices with cardiovascular risk factors and disease. Objective To describe application (app) design, report user characteristics, and describe usability and survey response rates. Methods Eligible FHS participants were consented and offered a smartwatch (Apple Watch), a digital blood pressure (BP) cuff, and the eFHS smartphone app for administering surveys remotely. We assessed usability of the new app using 2 domains (functionality, aesthetics) of the Mobile App Rating Scale (MARS) and assessed survey completion rates at baseline and 3 months. Results A total of 196 participants were recruited using the enhanced eFHS app. Of these, 97 (49.5%) completed the MARS instrument. Average age of participants was 53 ± 9 years, 51.5% were women, and 93.8% were white. Eighty-six percent of participants completed at least 1 measure on the baseline survey, and 50% completed the 3-month assessment. Overall subjective score of the app was 4.2 ± 0.7 on a scale from 1 to 5 stars. Of those who shared their health data with others, 46% shared their BP and 7.7% shared their physical activity with a health care provider. Conclusion Participants rated the new, enhanced eFHS app positively overall. Mobile app survey completion rates were high, consistent with positive in-app ratings from participants. These mobile data collection modalities offer clinicians new opportunities to engage in conversations about health behaviors.

Background: The most prominent risk factor for atrial fibrillation (AF) is chronological age; however, underlying mechanisms are unexplained. Algorithms using epigenetic modifications to the human genome effectively predict chronological age. Chronological and epigenetic predicted ages may diverge in a phenomenon referred to as epigenetic age acceleration (EAA), which may reflect accelerated biological aging. We sought to evaluate for associations between epigenetic age measures and incident AF. Methods: Measures for 4 epigenetic clocks (Horvath, Hannum, DNA methylation [DNAm] PhenoAge, and DNAm GrimAge) and an epigenetic predictor of PAI-1 (plasminogen activator inhibitor-1) levels (ie, DNAm PAI-1) were determined for study participants from 3 population-based cohort studies. Cox models evaluated for associations with incident AF and results were combined via random-effects meta-analyses. Two-sample summary-level Mendelian randomization analyses evaluated for associations between genetic instruments of the EAA measures and AF. Results: Among 5600 participants (mean age, 65.5 years; female, 60.1%; Black, 50.7%), there were 905 incident AF cases during a mean follow-up of 12.9 years. Unadjusted analyses revealed all 4 epigenetic clocks and the DNAm PAI-1 predictor were associated with statistically significant higher hazards of incident AF, though the magnitudes of their point estimates were smaller relative to the associations observed for chronological age. The pooled EAA estimates for each epigenetic measure, with the exception of Horvath EAA, were associated with incident AF in models adjusted for chronological age, race, sex, and smoking variables. After multivariable adjustment for additional known AF risk factors that could also potentially function as mediators, pooled EAA measures for 2 clocks remained statistically significant. Five-year increases in EAA measures for DNAm GrimAge and DNAm PhenoAge were associated with 19% (adjusted hazard ratio [HR], 1.19 [95% CI, 1.09–1.31]; P P Conclusions: Our study identified adjusted associations between EAA measures and incident AF, suggesting that biological aging plays an important role independent of chronological age, though a potential underlying causal relationship remains unclear. These aging processes may be modifiable and not constrained by the immutable factor of time.

Introduction: Bradyarrhythmias, diseases characterized by slow heart rates, are associated with substantial morbidity. Contemporary estimates of the frequency of bradyarrhythmias and associated outcomes in the community are needed. Methods: We examined the prevalence and incidence of bradyarrhythmias in a multi-institutional electronic health record cohort comprised of individuals receiving primary care. We used an automated tool to ascertain diagnoses from 12-lead electrocardiogram (ECG) diagnostic statements. We defined bradyarrhythmia groups based on location and severity of disease. We tested associations between clinical risk factors and incident bradyarrhythmia groups using multivariable proportional hazards regression. To characterize potential associations between bradyarrhythmias and major adverse cardiovascular events (MACE, a composite of myocardial infarction, heart failure, stroke, and death), we matched incident bradyarrhythmia and non-bradyarrhythmia individuals 1:1 on age, sex, and duration of preceding follow-up, and included bradyarrhythmia exposure in multivariable regression with MACE as the outcome. Results: Of a total of 520,868 individuals (mean age 48, 62% female, 3.5 million ECGs), the prevalence of any bradyarrhythmia was 10%. After excluding individuals with prevalent bradyarrhythmia, a total of 49,513 events occurred in 440,370 individuals as shown in Figure 1. Bradyarrhythmias were associated with common modifiable cardiovascular risk such as diabetes (HR 1.26, 95% CI [1.22-1.29]) and hypertension (HR 1.24, 95% CI [1.22-1.27]). Bradyarrhythmias were significantly associated with MACE in the atrioventricular delay (HR 1.07, 95% CI [1.01-1.14]) and conduction delay groups (HR 1.19, 95% CI [1.13-1.25]). Conclusions: Bradyarrhythmias are common and increase with older age and male sex. Incident bradyarrhythmias are associated with cardiovascular risk factors and may be associated with MACE.

There are large knowledge gaps regarding the global epidemiology of atrial fibrillation (AF), in part due to the paucity of informative community-based or population-based studies representative of the world’s population. The 2019 global burden of AF is estimated at 59.7 million (95% confidence interval: 45.7 to 75.3 million), double the number of estimated cases in 1990.1 Low-income nations—and one could argue entire continents such as South America, Africa and parts of Asia—face the multiple public health challenges of limited economic resources, progressively ageing populations, and increasing prevalence of common AF risk factors such as hypertension and obesity. Unfortunately, most of the literature describing the epidemiology of AF is from high-income countries, such as the USA, Western European countries and Australia. This literature has consistently described the prevalence of the condition, its significant medical and societal costs, and its priority as the most commonly encountered cardiovascular arrhythmia. In contrast, data from much of Asia, Africa and South America are less available. A Web of Science search for AF articles published over the past 5 years conducted on 14th December 2020 (figure 1) reinforces marked imbalances in the country of origin of the AF literature with regards to the number of publications versus the population. The bottom line is a literature that is hardly representative; a small percentage of the world’s population has produced a large quantity of the literature on a condition that is increasingly common and prevalent across the globe. To develop a more comprehensive picture of AF will require investigations that represent the socioeconomic and geographical complexities across multiple nations and continents. Figure 1 Atrial fibrillation (AF) research distribution according to the country within the last 5 years. The figure presents a Web of Science search for AF scientific papers published over the past 5 years conducted on 14th December 2020. In total, 43 509 …

Thermolesions are a dangerous complication of atrial fibrillation (AF) ablation. We aimed to assess the reasons for thermolesions and the effect of esophageal position on recurrences.The study included consecutive patients undergoing AF catheter ablation at Heart Center Leipzig between January and September 2014. We collected data of esophagus localization, temperature, endoscopy, and follow-up.The study included 645 patients into analyses. A total of 626 (97.2%) received a temperature probe. Esophageal position was categorized: (A) behind left pulmonary veins, (B) left ostial, (C) in the middle of left atrium, (D) right ostial, and (E) behind right pulmonary veins. The most frequent esophageal position was B-C (n = 201, 32.1%), followed by B (n = 161, 25.7%), and C (n = 147, 23.5%). The temperature was highest in A-B positions (42.04°C) and in D-E positions (41.70°C). There was a significant correlation between the endoscopically detected esophageal lesions (EDEL) and the esophageal position (r² = -.115, P = .004) and the esophageal temperature (r² = .162, P = .000), but not with body mass index (BMI) (r² = -.016, P = .688). Additional substrate modification in the left atrium resulted in significantly higher esophageal temperatures (P .001) and more frequent EDEL (P = .049). An EDEL was found in 15 patients (2.3% of all patients, 5.6% of patients receiving endoscopy). Of those, the median esophageal temperature was 41.8°C (interquartile range [IQR]: 41.2-42.4). Neither esophageal position nor temperature during ablation was associated with arrhythmia recurrences (both P .400).EDEL depended on the esophageal position and temperature, but not on BMI. Esophageal position and intraluminal temperature during ablation had no effect on recurrences.

Background: The P-wave duration (PWD) is an electrocardiographic measurement that represents cardiac conduction in the atria. Shortened or prolonged PWD is associated with atrial fibrillation (AF). We used exome-chip data to examine the associations between common and rare variants with PWD. Methods: Fifteen studies comprising 64 440 individuals (56 943 European, 5681 African, 1186 Hispanic, 630 Asian) and ≈230 000 variants were used to examine associations with maximum PWD across the 12-lead ECG. Meta-analyses summarized association results for common variants; gene-based burden and sequence kernel association tests examined low-frequency variant-PWD associations. Additionally, we examined the associations between PWD loci and AF using previous AF genome-wide association studies. Results: We identified 21 common and low-frequency genetic loci (14 novel) associated with maximum PWD, including several AF loci ( TTN , CAND2 , SCN10A , PITX2 , CAV1 , SYNPO2L , SOX5 , TBX5, MYH6, RPL3L ). The top variants at known sarcomere genes ( TTN, MYH6 ) were associated with longer PWD and increased AF risk. However, top variants at other loci (eg, PITX2 and SCN10A ) were associated with longer PWD but lower AF risk. Conclusions: Our results highlight multiple novel genetic loci associated with PWD, and underscore the shared mechanisms of atrial conduction and AF. Prolonged PWD may be an endophenotype for several different genetic mechanisms of AF.

Electro-anatomical remodeling in atrial fibrillation (AF) is associated with disease initiation and progression. Troponin T (TropT) - a specific biomarker for myocardial damage - is associated with AF incidence. However, its association with AF progression is understudied. The aim of the current analysis was to investigate the association between TropT and AF progression phenotypes: persistent AF and left atrial low voltage areas (LVAs).Patients undergoing first AF ablation were included into analyses. LVAs were determined using high-density maps and defined as0.5 mV. Blood samples from femoral vein were collected before catheter ablation. The analysis of TropT serum concentrations was performed using a high-sensitive assay from Roche Diagnostics. Biomarkers, clinical, anthropometric and echocardiographic data were compared with healthy individuals from the epidemiological cohort.The study included 824 healthy individuals without overt cardiovascular disease (54 ± 10 years, 40% males) from epidemiological cohort and 241 AF patients (64 ± 11 years, 59% males, 59% persistent AF, 27% LVAs). Patients with AF had higher TropT levels and larger left atrium (LA), while healthy individuals had better renal function and ejection fraction (all p 0.001). In clinical cohort, there were significant differences between TropT levels according to AF progression groups: paroxysmal AF without/with LVAs (n = 86/12), persistent AF without/with LVAs (n = 90/53): means 7.3, 12.9, 8.4, 11.3 pg/ml, p 0.001, respectively. Similar findings were observed for LA and renal function (all p 0.001). On ROC analysis, TropT significantly predicted LVAs (AUC 0.675, 95%CI 0.598-0.752, p 0.001) in AF patients.TropT may be useful to differentiate AF progression phenotypes.

Aims Arrhythmia recurrences after catheter ablation of atrial fibrillation (AF) still remain an important management issue. Recently, the APPLE score had been introduced to predict rhythm outcomes within 12 months after catheter ablation, while the simple MB-LATER score was developed for the prediction of very late recurrence of AF (VLRAF) occurring after 12 months. The aim of this study was to compare APPLE and MB-LATER scores in predicting VLRAF. Methods and results The study population included arrhythmia-free patients within first 12 months after first radiofrequency catheter ablation from The Heart Center Leipzig AF Ablation Registry. The APPLE [one point for Age >65 years, Persistent AF, imPaired eGFR 120 ms, LA diameter ≥47 mm, AF Type (persistent AF), Early Recurrence Conclusion Prediction of VLRAF is similar for both APPLE and MB-LATER scores. A better score remains still a clinical unmet need.

BACKGROUND The prevalence of obesity is rising. Most previous studies that examined the relations between BMI and physical activity (PA) measured BMI at a single timepoint. The association between BMI trajectories and habitual PA remains unclear. OBJECTIVE This study assesses the relations between BMI trajectories and habitual step-based PA among participants enrolled in the electronic cohort of the Framingham Heart Study (eFHS). METHODS We used a semiparametric group-based modeling to identify BMI trajectories from eFHS participants who attended research examinations at the Framingham Research Center over 14 years. Daily steps were recorded from the smartwatch provided at examination 3. We excluded participants with RESULTS We identified 3 trajectory groups for the 837 eFHS participants (mean age 53 years; 57.8% [484/837] female). Group 1 included 292 participants whose BMI was stable (slope 0.005; P=.75), group 2 included 468 participants whose BMI increased slightly (slope 0.123; PP CONCLUSIONS In this community-based eFHS, participants whose BMI trajectory increased greatly over time took significantly fewer steps, compared with participants with stable BMI trajectories. Our findings suggest that greater weight gain may correlate with lower levels of step-based physical activity.

Introduction: The prevalence of obesity is rising. Most previous studies that examined the relationship between body mass index (BMI) and physical activity measured BMI at a single time-point, ignoring the time-varying nature of BMI. The relationship between BMI trajectories and habitual physical activity in community settings remains unclear. Objective: To assess the relationship between BMI trajectories and habitual physical activity measured by daily steps from a smartwatch, among participants enrolled in the electronic Framingham Heart Study (eFHS). We hypothesized that participants whose BMI trajectories increased over a 14-year period prior to the step assessment take fewer daily steps, compared to participants who maintained stable BMI trajectories during the same time period. Methods: We used a semiparametric group-based modelling method to identify BMI trajectory patterns. Participants who attended exams 1, 2, and 3 were included in building the trajectories. Daily steps were recorded from the smartwatch provided at exam 3 with “active days” defined as days with ≥ 5watch wear-hours. We excluded participants with Results: We identified three trajectory groups for the 837 eFHS participants. Group 1 included 292 participants (mean age 54 years, 57% women) whose BMI was stable (slope: 0.005, p=0.75); Group 2 included 468 participants (mean age 53 years, 56% women) whose BMI increased slightly (slope: 0.123, p Conclusion: Participants whose BMI trajectory increased over time took significantly fewer steps compared to participants with more stable BMI trajectories. Our findings suggest that levels of physical activity may correlate with greater weight gain during adulthood.

Introduction: Long-term use is critical for successful clinical or research applications of digital devices, but digital health studies are challenged by significant early discontinuation of use. Hypothesis: We sought to identify factors associated with long-term use of a smartwatch among participants enrolled in the electronic Framingham Heart Study (eFHS). We hypothesized that sociodemographic and health variables are associated with watch use. Methods: Participants were provided with a study smartwatch and were asked to wear the watch daily. We examined watch use over 12 months. Weekly watch use was defined as a binary response (yes=watch wear for ≥1 days for ≥ 5 hours per day, vs. no). We considered 19 different predictors including sociodemographic, health behaviors, and family relationship. We selected an individual predictor for watch use ( P Results: Among 1243 participants (mean age 53 years, 59% women), watch use was highest in the age-group ≥65 years, and decreased linearly over time in all participants (Figure). In GLMM adjusted for age, sex, and weeks, we found that self-reported health status (excellent vs good, fair or poor) (OR=2.7; 95%CI, 1.6-4.8), BMI (OR=0.9; 95%CI, 0.9-1.0) per 1 kg/m 2 increase, and depressive symptoms (OR=0.5; 95%CI, 0.3-0.8) were associated with watch use. In the model with all selected predictors, age-group > 65 (OR=4.0; 95%CI, 1.4 -11.6), excellent health (OR=2.3; 95%CI, 1.3-4.1), and depressive symptoms (OR=0.5; 95%CI, 0.3-0.9) remained significant. Conclusions: Older age, lack of depressive symptoms, and self-reported excellent health were associated with greater use of the smartwatch over the 12-month follow-up. Consideration of these factors in planning future digital studies may improve participation.

Introduction: The electronic Framingham Heart Study (eFHS) is an ongoing study nested within the Framingham Heart Study. eFHS examines associations between health data measured by mobile devices and cardiovascular risk and disease. We aim to describe the eFHS app design and deployment methodology, report the characteristics of the eFHS app users, and describe usability of the app. Hypothesis: We hypothesize that eFHS participants will find the app highly usable. Methods: Participants were eligible if they were part of FHS, had a mobile phone, and were willing to share data with the research center. After consent, they received a smartwatch, digital blood pressure (BP) cuff, and the eFHS smartphone app through which surveys were administered. Three years later, the app was enhanced to include an interactive health dashboard to promote participant engagement and facilitate survey completion. We assessed usability of the new app with the Mobile App Rating Scale (MARS) (specifically app functionality and aesthetics), and survey completion rates at baseline (measures include socio-demographics, self-reported health and health behaviors, and medical history) and 3 months (physical activity). Results: A total of 196 participants were recruited using the enhanced eFHS app. Of these, 97 (49.5%) completed the MARS. The average age of survey respondents was 53 years, 51.5% were women, 93.8% were white. At least one instrument of the baseline survey was completed by 86% of participants, and 50% completed the 3-month assessment. The mean score on the “overall impression” subscale of the MARS was 4.2 (SD 0.74) on a scale of 1 to 5, with all sub-domains scoring > 4.0. Of those who shared their health data with others, 46% shared their BP data, and 7.7% shared their physical activity data with a healthcare provider. Conclusion: Participants rated the new, enhanced eFHS app positively overall. Mobile app survey completion rates were moderate, suggesting that mHealth-delivered cardiovascular research is feasible.