Center for Digital Health and Telemedicine

Overview

Ninety percent of Americans are connected to the internet, and 77% of them own a smartphone. These trends have laid the foundation for a digital health revolution to transform healthcare delivery, especially in cardiovascular care. Cardiovascular digital technology products include wearable and/or portable devices and apps used to monitor cardiovascular measurements.

Of issue is a substantial gap between technology advancements and changing behavior, and the expansion of digital health has not been matched by proper testing or oversight. Additionally, this unprecedented acceleration in technology raises the question of our patients’ ability to adapt to these constantly evolving tools used in their daily care. Most importantly, there is an urgent need to understand if these products can change outcomes, rather than simply record data.

Objectives

The objectives of the HVI Center for Digital Health Technologies are to:

• Explore and evaluate cardiovascular digital technology products, including wearable devices, smart phone-enabled devices and apps
• Assess patient adoption of new technology
• Measure acceptance and outcomes of cardiovascular digital technology
• Determine the impact of digital technology on healthcare providers, including changes in clinical care, workflow and the ability to keep up with the pace of technology advancements
• Provide guidance regarding use of devices for patients, healthcare providers and the healthcare system in general

The HVI Center for Digital Health Technologies will connect technology and innovation with testing and research and, most importantly, the clinical experts and patients to improve patient care, safety and experience in the future.

Our Team

The HVTI Center for Digital Health Technologies includes a multidisciplinary team of medical experts who are committed to enhancing digital health in a variety of cardiovascular settings.

• Dennis Bruemmer, MD, PhD – Cardiometabolic Health, Section of Preventive Cardiology
• Michael Emery, MD, MS - Sports Cardiology Center
• Erik Van Iterson, PhD, MS – Preventive Cardiology and Cardiac Rehabilitation
• Wael Jaber, MD – Cardiovascular Imaging
• Deborah Kwon, MD – Cardiovascular Imaging
• Luke Laffin, MD – Preventive Cardiology
• Nicholas Ruthmann, MD - Clinical Cardiology
• Ramzi Souki, MD – Pediatric Cardiology 
• Wai Hong Wilson Tang, MD – Heart Failure 

Additional experts from a variety of Cleveland Clinic resources including informatics and technology, research and legal departments assist in the evaluation and application of products, providing an atmosphere of innovation and collaboration.

Research & Publications

1. Gautam V Shah, Ankur Kalra, Umesh N Khot, Transforming community cardiology practice to virtual visits: innovation at Cleveland Clinic during the COVID-19 pandemic, European Heart Journal, 2021;, ehab684, https://doi.org/10.1093/eurheartj/ehab684
2. Performance of first pacemaker to use smart device app for remote monitoring.  Tarakji KG, Azidi AM, Zweibel SL, Varma N, Holloman K, Natera AC, Turakhia MP, et. al. Heart Rhythm O2 , Published August 2,2021 DOI: https://doi.org/10.1016/j.hroo.2021.07.008
3. Atrial fibrillation future clinic. Novel platform to integrate smart device electrocardiogram into clinical practice. Cameron T. Lambert, MD, Divyang Patel, MD, Joseph M. Bumgarner, MD, Mohamed Kanj, MD, Daniel Cantillon, MD, FHRS, Walid Saliba, MD, Ayman Hussein, MD, FHRS, Bryan Baranowski, MD, Thomas Dresing, MD, Mina K. Chung, MD, FHRS, John Rickard, MD, MPH, Niraj Varma, MD, PhD, Thomas Callahan, MD, FHRS, David Martin, MD, Patrick Tchou, MD, FHRS, Mandeep Bhargava, MD, Kathy Wolski, MS, Oussama Wazni, MD, FHRS, Khaldoun G. Tarakji, MD, MPH, FHRS.   Cardiovascular Digital Health Journal, Published March 03, 2021.  DOI:https://doi.org/10.1016/j.cvdhj.2021.02.002.
4. Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu YF, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini JP, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society. Circ Arrhythm Electrophysiol . 2021 Feb;14(2):e009204. doi: 10.1161/CIRCEP.120.009204. Epub 2021 Feb 12. PMID: 33573393; PMCID: PMC7892205.
5. Bayoumy, K., Gaber, M., Elshafeey, A. et al. Smart wearable devices in cardiovascular care: where we are and how to move forward.  Nat Rev Cardiol (2021). https://doi.org/10.1038/s41569-021-00522-7.
6. Farwati, M., Riaz, H. & Tang, W.H.W. Digital Health Applications in Heart Failure: a Critical Appraisal of Literature. Curr Treat Options Cardio Med 23, 12. 2021, JAN 16. https://doi.org/10.1007/s11936-020-00885-z.  https://link.springer.com/article/10.1007/s11936-020-00885-z
7. Patel D, Tarakji KG.  Smart watch AF detection after cryptogenic stroke, Cardiovascular Digital Health Journal. 2021 Jan 12. https://doi.org/10.1016/j.cvdhj.2021.01.001 .
   https://www.cvdigitalhealthjournal.com/article/S2666-6936(21)00002-5/fulltext
8. Anjewierden S, Humpherys J, LaPage MJ, Asaki SY, Aziz PF. Detection of Tachyarrhythmias in a Large Cohort of Infants using Direct-to-Consumer Heart Rate Monitoring, The Journal of Pediatrics. 2021 Jan 05. https://doi.org/10.1016/j.jpeds.2020.12.080.  https://www.jpeds.com/article/S0022-3476(21)00002-0/fulltext
9. Tarakji KG, Silva JNA, Chen LY, Turakhia MP, Perez MV, Attia ZI, Passman R, Boissy A, Cho DJ, Majmudar M, Mehta N, Wan EY, Chung MK. Digital Health and the Care of the Arrhythmia Patient; What Every Electrophysiologist Needs to Know. Circ Arrhythm Electrophysiol. 2020 Oct 6. doi: 10.1161/CIRCEP.120.007953. Epub ahead of print. PMID: 33021815 https://pubmed.ncbi.nlm.nih.gov/33021815/
10. Gorodeski, EZ, Goyal, P, Cox, ZL, Rasmusson, K, Rogers, JG, Starling, RC. Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America, Journal of Cardiac Failure, VOLUME 26, ISSUE 6, P448-456, JUNE 01, 2020 https://www.onlinejcf.com/article/S1071-9164(20)30367-5/fulltext
11. Gorodeski EZ, Moennich LA, Riaz H, Jehi L, Young JB, Tang WHW. Virtual Versus In-Person Visits and Appointment No-Show Rates in Heart Failure Care Transitions. Circ Heart Fail. 2020 Aug;13(8):e007119. doi: 10.1161/CIRCHEARTFAILURE.120.007119. Epub 2020 Jul 30. PMID: 32762457. https://pubmed.ncbi.nlm.nih.gov/32762457/ 
12. Ding EY, Svennberg E, Wurster C, Duncker D, et. al. Survey of current perspectives on consumer-available digital health devices for detecting atrial fibrillation, Cardiovascular Digital Health Journal 2020;1:21–29, https://www.cvdigitalhealthjournal.com/action/showPdf?pii=S2666-6936%2820%2930004-9
13. Feeny AK, Chung MK, Madabhushi A, et al. Artificial Intelligence and Machine Learning in Arrhythmias and Cardiac Electrophysiology [published online ahead of print, 2020 Jul 6]. Circ Arrhythm Electrophysiol. 2020;10.1161/CIRCEP.119.007952. doi:10.1161/CIRCEP.119.007952
14. Hu PT, Hilow H, Patel D, et al. Use of Virtual Visits for the Care of the Arrhythmia Patient [published online ahead of print, 2020 May 10]. Heart Rhythm. 2020;S1547-5271(20)30432-X. doi:10.1016/j.hrthm.2020.05.011 https://pubmed.ncbi.nlm.nih.gov/32438016/
15. Seshadri DR1, Bittel B2, Browsky D2, Houghtaling P2, Drummond CK1, Desai MY2, Gillinov AM2. Accuracy of Apple Watch for Detection of Atrial Fibrillation. Circulation. 2020 Feb 25;141(8):702-703. doi: 10.1161/CIRCULATIONAHA.119.044126. Epub 2020 Feb 24.  https://www.ncbi.nlm.nih.gov/pubmed/32091929 
16. Mehta S, Mehta N, Tang WH, Young J. Cardiologists' Perceptions of Wearable Device in Patients with HF. J Gen Intern Med. 02 January 2020
    DOI: 10.1007/s11606-019-05390-z https://link.springer.com/article/10.1007/s11606-019-05390-z. 
17. Seshadri DR1, Bittel B2, Browsky D2, Houghtaling P2, Drummond CK1, Desai M2, Gillinov AM2. Accuracy of the Apple Watch 4 to Measure Heart Rate in Patients With Atrial Fibrillation. IEEE J Transl Eng Health Med. 2019 Dec 13;8:2700204. doi: 10.1109/JTEHM.2019.2950397. eCollection 2020. https://www.ncbi.nlm.nih.gov/pubmed/32128290 
18. Levy AE, Biswas M, Weber R, Tarakji K, Chung M, Noseworthy PA, Newton-Cheh C, Rosenberg MA. Applications of machine learning in decision analysis for dose management for dofetilide. PLoS One. 2019 Dec 31;14(12):e0227324.
    doi: 10.1371/journal.pone.0227324. eCollection 2019. https://www.ncbi.nlm.nih.gov/pubmed/31891645.
19. Cameron T. Lambert, MD1; Joseph M. Bumgarner, MD1; Khaldoun G. Tarakji, MD, MPH1. Atrial Fibrillation Detection With Wearable Devices. JAMA. 2019;321(23):2367-2368. doi:10.1001/jama.2019.4538 https://jamanetwork.com/journals/jama/fullarticle/2735811.
20. Slotwiner DJ1, Tarakji KG2, Al-Khatib SM3, Passman RS4, Saxon LA5, Peters NS6, McCall D7; Advisors. Transparent sharing of digital health data: A call to action. Heart Rhythm. 2019 May 8. pii: S1547-5271(19)30371-6.  doi:
    10.1016/j.hrthm.2019.04.042. https://www.sciencedirect.com/science/article/pii/S1547527119303716?via%3Dihub.
21. Hussein AA1, Lindsay B1, Madden R1, Martin D1, Saliba WI1, Tarakji KG1, Saqi B1, Rausch DJ1, Dresing T1, Callahan T1, Chung MK1, Baranowski B1, Bhargava M1, Cantillon D1, Rickard J1, Kanj M1, Tchou P1, Wilkoff BL1, Nissen SE1, Wazni OM1. New Model of Automated Patient-Reported Outcomes Applied in Atrial Fibrillation. Circ Arrhythm Electrophysiol. 2019 Mar;12(3):e006986.
    doi: 10.1161/CIRCEP.118.006986. https://www.ahajournals.org/doi/full/10.1161/CIRCEP.118.006986?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed.
22. Machine Learning Prediction of Response to Cardiac Resynchronization Therapy: Improvement Versus Current Guidelines. Feeny AK, Rickard J, Patel D, Toro S, Trulock KM, Park CJ, LaBarbera MA, Varma N, Niebauer MJ, Sinha S, Gorodeski EZ, Grimm RA, Ji X, Barnad J, Madabhushi A, Spragg DD, Chung MK. Circulation: Arrhythmia and Electrophysiology https://www.ahajournals.org/doi/abs/10.1161/CIRCEP.119.007316. 2019 Jul;12(7):e007316.
23. The gap between what patients know and desire to learn about their cardiac implantable electronic devices. Patel D1, Hu P1, Hilow H1, Lambert CT1, Moufawad M1, Poe S1, Hussein AA1, Baranowski B1, Bhargava M1, Rickard JW1, Cantillon DJ1, Saliba W1, Wilkoff BL1, Wazni O1, Tarakji KG1. Pacing Clin Electrophysiol. 2019 Nov 28.
    doi: 10.1111/pace.13850. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/31782195.
24. Smartwatch Algorithm for Automated Detection of Atrial Fibrillation. Bumgarner JM, Lambert CT, Hussein AA, Cantillon DJ, Baranowski B, Wolski K, Lindsay BD, Wazni OM, Tarakji KG.
    J Am Coll Cardiol. 2018 May 29;71(21):2381-2388.
    doi: 10.1016/j.jacc.2018.03.003. Epub 2018 Mar 10
25. Assessing the Accuracy of an Automated Atrial Fibrillation Detection Algorithm Using Novel Smartphone Technology (iREAD STUDY).  Amila D. William MD, Majd Kanbour MD, Thomas Callahan MD, Mandeep Bhargava MD, Ayman Hussein MD, Niraj Varma MD, John Rickard MD, Walid Saliba MD, Kathy Wolski MPH, Oussama M. Wazni MD, Khaldoun G. Tarakji MD MPH.
    Heart Rhythm. 2018 Aug 16. pii: S1547-5271(18)30661-1.
    doi: 10.1016/j.hrthm.2018.06.037.
26. Success of pacemaker remote monitoring using app based technology: does patient age matter?  Tarakji KG, Vives CA, Patel AS, Fagan DH, Sims JJ, Varma N.
    Pacing Clin Electrophysiol. 2018 Jul 28.
    doi: 10.1111/pace.13461. [Epub ahead of print]
27. Variable Accuracy of Wearable Heart Rate Monitors during Aerobic Exercise.  Gillinov S, Etiwy M, Wang R, Blackburn G, Phelan D, Gillinov AM, Houghtaling P, Javdikasgari H, Desai MY.
    Med Sci Sports Exerc. 2017 Aug;49(8):1697-1703.
    doi: 10.1249
28. Accuracy of Wrist-Worn Heart Rate Monitors.  Wang R, Blackburn G, Desai M, Phelan D, Gillinov L, Houghtaling P, Gillinov M.  JAMA Cardiol. 2017 Jan 1;2(1):104-106.
    doi: 10.1001/jamacardio.2016.3340.
29. Home monitoring of heart failure patients at risk for hospital readmission using a novel under-the-mattress piezoelectric sensor: A preliminary single centre experience.  Bennett MK, Shao M, Gorodeski EZ.  J Telemed Telecare. 2017 Jan;23(1):60-67.
    doi: 10.1177/1357633X15618810. Epub 2016 Jul 9
30. Using a novel wireless system for monitoring patients after the atrial fibrillation ablation procedure: the iTransmit study.  Tarakji KG, Wazni OM, Callahan T, Kanj M, Hakim AH, Wolski K, Wilkoff BL, Saliba W, Lindsay BD.  Heart Rhythm. 2015 Mar;12(3):554-559.
    doi: 10.1016/j.hrthm.2014.11.015. Epub 2014 Nov 18.

Tall Rounds® Sessions

Digital Health and the Care of the Cardiovascular Patient, 8/27/2020

Talking Tall Rounds® Podcast

Digital Health and Cardiovascular Disease Management, September 24, 2020

News

• Wearables and the Electrophysiology Practice: Challenges and Opportunities, EPLabDigest, Khaldoun G. Tarakji, MD, MPH, article and podcast, 8/3/2020 
• The Rise of Wearables: What Experts Say About Patients, Platforms & Getting Paid by Kathy Boyd David 9/10/2019
• Patients Often Lack Basic Knowledge About Their Implanted Devices by Todd Neale, tctMD/the heart beat, 5/8/2019
• Wearable Health Monitors: Do They Work? Deborah Gage, Wall Street Journal, 9/16/2018
• Smartwatch Device Accurately Detects A-fib Before Cardioversion, Neale T, tctMD, 3/2/2018
• Freed From the iPhone, the Apple Watch Finds a Medical Purpose – Wakabayashi D, The New York Times, 2017-Dec-26
• FDA Clears AliveCor's Apple Watch ECG Device – Kincaid E. Forbes. 2017-Nov-30
• The Apple Watch Is the Most Accurate Wrist Wearable – Oaklander M. Time. 2016-Oct-12
• AliveCor studies show value for atrial fibrillation screening, von Portz, G, iMedicalApps, Medpage Today, 9/12/2017
• Mobile EKG monitor looks to help atrial fibrillation patients, Gorman, A, ABC-WPVI-TV, Philadelphia, PA, 5/1/2017
• You Can Monitor Heart Rhythm With A Smartphone, But Should You? Ross, E, NPR, 10/15/2016
• Wearable health monitors not always reliable, study shows, Weintraub, K, USA Today, 10/12/2016

Consult QD

• Digital Remote Blood Pressure Management: Has Its Time Come? 9/2020 
• Virtual Visits for Arrhythmia Patients: Looking Back to Look Forward, 6/10/2020
• Expanding Uses of Blood Pressure Monitoring Technologies Fuel Two New Research Studies, 4/22/2020
• Direct Pacemaker Monitoring Via Smartphone Enables High Rates of Transmission Success, 5/8/2020
• Patients Know Less Than They Think About Their CIEDs, Survey Finds, 1/15/2020
• Study Enrolls First US Patient to Use a Smartphone for Direct Pacemaker Monitoring, 7/25/2018
• Smartwatch Technology Detects Afib Prior to Cardioversion, 03/9/2018
• How Electrophysiologists Are Turning to Tech to Transform Outpatient Care, 8/31/2017
• Virtual Reality: Can It Train You to Do Heart Surgery?, 03/01/2018

Contact

If you would like to learn more about the HVI Center for Digital Health Technologies or collaborate on innovative digital technologies for cardiovascular care, please contact:

Khaldoun Tarakji, MD, MPH
HVI Center for Digital Health Technologies
Cleveland Clinic
9500 Euclid Ave.
Desk J2-2
Cleveland, OH 44195
216.445.9225