Søren Paaske Johnsen

BACKGROUND Background: Atrial fibrillation (AF) is a growing global health challenge associated with substantial morbidity, reduced quality of life, and increased healthcare utilization. Digital health technologies applied to telerehabilitation have shown the potential to support individuals’ engagement and enhanced self‑management during rehabilitation. However, little is known about how individuals with AF use digital platforms in real‑world settings, and log‑file analyses remain underexplored. OBJECTIVE Objective: This study aimed to elucidate how individuals with AF engaged with a digital connection to the healthcare system. This connection was provided through the HeartPortal, a web based platform offering clinically validated educational material, access to patient reported and device generated health data, and secure communication channels that support coordination of rehabilitation activities. The study examined how participants accessed educational materials, reviewed their personal health data, and communicated with healthcare professionals throughout a 28 week telerehabilitation program. METHODS Methods: This study analyzed log file data from 101 participants enrolled in the intervention group of the Future Patient—Telerehabilitation of Patients with AF (FP AF) randomized controlled trial. Log data was generated through participants’ use of the HeartPortal. Log data included timestamps for page visits, messaging activity, video consultations, and patients’ written narratives of goals and notes. Descriptive statistics were generated using Python to quantify usage patterns across features, weekly activity levels, and temporal trends. An additional analysis examined how activity was distributed across participants, assessing whether HeartPortal visits and messaging activity were driven by a small subset of highly active users or more evenly shared across the cohort. Data was supplemented with system level information on healthcare professional activity. RESULTS Results: HeartPortal use peaked during the first 17 weeks, when over 80% of participants accessed the platform weekly, and decreased after monitoring equipment was returned. Activity in the most frequently used sections varied markedly, with the most active 25% maintaining higher engagement throughout the intervention. Participants sent 1,167 messages and healthcare professionals sent 1,705, with messaging peaking in week 6. CONCLUSIONS Conclusions: The HeartPortal was primarily used for reviewing personal health data and communicating with healthcare professionals, indicating that digital platforms can support self management in AF telerehabilitation. Limited engagement with educational content may reflect patients’ existing knowledge at baseline or a need to refine digital learning components to better match users’ needs. These findings demonstrate the value of log file analysis for understanding real world behaviour and point to future research on how digital platforms can sustain engagement and enhance patient education. CLINICALTRIAL Name: Future Patient - Telerehabilitation of Atrial Fibrillation Patients ClinicalTrials.gov (NCT04493437) URL: https://clinicaltrials.gov/study/NCT04493437 INTERNATIONAL REGISTERED REPORT RR2-10.2196/64259

Background: Sex disparities in outcomes after endovascular thrombectomy (EVT) for large vessel occlusion stroke in patients with atrial fibrillation (AF) remain unclear. This study examined sex differences in outcomes following EVT according to AF status. Methods: Using the nationwide Danish Stroke Registry, adults with first‐time ischemic stroke involving anterior and posterior circulation large vessel occlusion treated with EVT from 2015 to 2020 were included. Outcomes included 90‐day good functional outcome (modified Rankin Scale score ≤2), successful reperfusion (modified Thrombolysis in Cerebral Infarction ≥2b), symptomatic intracranial hemorrhage, and mortality. Multivariable logistic regression assessed associations between AF and outcomes stratified by sex, including sex‐and‐age interactions. Results: Among 2542 EVT‐treated patients (median age 72.5 years; 43.2% women), 729 (28.7%) had AF. Women with AF had higher odds of good functional outcome than women without AF (adjusted OR [aOR], 1.48 [95% CI, 1.10–1.99]). Men with AF had similar odds of good functional outcome as men without AF (aOR, 1.17 [95% CI, 0.90–1.53]) but higher odds of successful reperfusion (aOR, 2.04 [95% CI, 1.37–3.02]). No differences by sex or AF status were observed for excellent functional outcomes, symptomatic intracranial hemorrhage, or mortality. Among men, older men with AF was associated with higher odds of successful reperfusion compared with older men without AF ( P _interaction <0.001). Conclusions: Among patients undergoing EVT for large vessel occlusion stroke in Denmark, women with AF had higher odds of good functional outcome and men with AF showed higher successful reperfusion rates with advancing age. Safety and mortality outcomes were similar across groups with AF. These findings suggest age‐and sex‐specific influences on EVT outcomes associated with AF.

Introduction Telehealth, including remote monitoring, has the potential to reduce healthcare resource use. However, economic evaluations often have insufficient methodological quality, including long-term investigation. The problem is that data are often unavailable for the entire time horizon of interest, but here different extrapolation methods can be applied. Objective The objective of this study is to examine how long-term economic evaluations of telehealth interventions (remote monitoring) have been designed and conducted with a particular focus on extrapolation methods, and to identify the applied extrapolation methods. Methods This scoping review was conducted according to guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). The systematic search in Embase, PubMed, EconLit, Web of Science, NHS Economic Evaluation Database, and CINAHL, supplemented with a grey literature search in Google Scholar, identified economic evaluations, where minimum one alternative was telehealth, the time horizon exceeded 12 months, and extrapolation methods were applied. Last search date was 23 January 2025, and two reviewers screened the studies simultaneously. Data were extracted using a predefined data extraction sheet. Results A total of 57 studies were included in this scoping review. Use of simpler extrapolation methods (Profiles and Constant values) was prevalent in 84% and 57% of the studies, respectively. These simple methods were used both in combination and alone. Even when trial-based data were available for a shorter time horizon, the simpler methods were used just as frequently as the more advanced methods. Only 32% of the studies included a sensitivity analysis for investigating the impact of the time horizon on the decision. Furthermore, transparency was missing in the reporting of applied extrapolation methods, and explicit investigation of uncertainty from the choice of extrapolation method is warranted. Conclusions This scoping review finds that economic evaluations of telehealth interventions (remote monitoring) mainly rely on simpler extrapolation methods with limited justification, validation, and uncertainty analysis. Further investigation into the implications of use of different extrapolation methods is warranted, and guidelines on use of extrapolation methods are needed to ensure transparency. Registration A protocol was published elsewhere.

Background: Previous studies show ambiguous results concerning quality of palliative care among patients with severe mental disorders, defined as schizophrenia, moderate to severe depression, and bipolar disorders. Aim: To investigate quality in specialist palliative care among Danish patients with pre-existing severe mental disorders using data from the Danish Palliative Database. Design: Danish cohort study linking data from the Danish Palliative Database and hospital medical files. Setting/participants: All adult decedents in 2023 from Central Denmark Region affiliated with specialist palliative care. Hospital records were screened for severe mental disorders. Quality indicators included: Place-of-death, days from referral to death, specialist palliative care waiting time, discussion at multidisciplinary conferences and completion of symptom assessment. Results: Of 1869 patients, 80 (4.3%) had pre-existing severe mental disorders. Compared to patients without mental disorders, these patients died younger and more often from non-cancer conditions. They were less likely to complete symptom assessment (Risk Ratio (RR): 1.49 (95% CI: 1.15;1.95)). Those who also received active psychiatric treatment experienced longer waiting times for specialist palliative care (Mean ratios (MR): 3.48 (95% CI: 1.06;11.39)) and shorter palliative care pathways (MR: 0.44 (95% CI: 0.20;0.96)) than patients without active psychiatric treatment. Conclusion: Danish patients with active severe mental disorders were less likely to complete symptom assessment, had longer waiting times and shorter specialist palliative care pathways. Future efforts should focus on timely access to specialist palliative care and health professionals supporting completion of symptom assessments in this population.

Aims: Comparing temporal trends in the incidence and prevalence of major cardiovascular diseases (CVDs) provides insights into their evolving relative burden. We examined incidence and prevalence trends of atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI), and stroke from 2000 to 2022 and projected these measures to 2040. Methods and results: In this Danish nationwide cohort study, we analysed data from national registries and Statistics Denmark for individuals aged 20–94 years. Each CVD was modelled separately using a statistical framework combining parametric survival modelling with an age-period-cohort incidence model, accounting for temporal trends and enabling future burden extrapolation. From 2000 to 2022, AF incidence increased, while HF, MI, and stroke incidences decreased. The prevalence of all four conditions increased. By 2040, AF incidence in Denmark is projected to rise by 28% from 20 683 to 26 376 new cases, and prevalence by 56% from 175 697 to 274 379 cases. HF and stroke incidences are expected to decrease by 2%, while MI incidence will decline by 30%. HF and stroke prevalence are projected to increase by 52% and 31%, respectively, whereas MI prevalence will decrease by 3%. Among individuals aged 65–94 years, new AF cases are projected to surpass the combined new cases of HF, MI, and stroke in 2040. Conclusion: AF has become the most frequently diagnosed and prevalent major CVD, with a growing burden surpassing HF, MI, and stroke in older adults. These findings underscore the urgent need for updated healthcare policies and integrated care strategies to address the growing burden of AF.