Aileen Zeng

Background: Continuous adhesive patch electrocardiographic (ECG) wearables are increasingly prescribed. Patient experience with these devices can influence adherence, but research in this area is limited. This study aimed to explore the perceptions and experiences of patients receiving wearable cardiac monitoring technology as part of their routine care through the lens of treatment burden. Methods: This was a qualitative study with semi-structured phone interviews conducted between February and May 2024. We recruited participants from primary care and outpatient clinics using maximum variation sampling to ensure diversity in sex, ethnicity, and education levels. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Results: Sixteen participants (mean age 51 years, 63% female) were interviewed (average duration: 33 minutes). Three themes were developed: 1) ?Experience using the device: Burden vs Ease of Use?, which captured participants? perceptions of how easily they could integrate the device in their daily lives; 2) ?Individual variability in responses to ECG self-monitoring? covered participants? emotional and cognitive response to knowing their heart rhythm was monitored; and 3) ?The care process shapes patient experiences? reflected support preferences during the set-up and monitoring period and the uncertainty regarding timely clinical and device feedback. Conclusions: Patients valued cardiac wearables for facilitating diagnosis and felt reassured knowing they were clinically monitored. However, gaps in information provided to patients seemed to cause anxiety for some participants. These concerns could be mitigated through clearer clinician communication and patient education at the time of prescription.

Background: Clinical guidelines recommend the early initiation of secondary prevention strategies prior to hospital discharge for patients with myocardial infarction (MI) to reduce morbidity and mortality, but implementation is resource-intensive. Multilingual videos can deliver information in diverse preferred languages and literacy levels, but their impact on MI knowledge among hospitalized patients remains unclear. Objective: This study aims to assess whether the delivery of a multilingual educational video to hospitalized patients with MI can improve patient MI knowledge before hospital discharge. Methods: We conducted a single-arm pre-post study with embedded formative implementation evaluation from December 2023 to October 2024 in a tertiary hospital. The intervention was a video on post-MI management, available in English, Arabic, Hindi, and Mandarin (with Simplified Chinese subtitles). The intervention was delivered via a tablet provided by the research assistant. The primary outcome was the change in patient knowledge of MI, measured by comparing the mean number of correct responses before and after the intervention using a 2-tailed paired t test. We assessed early-stage implementation using 2 prespecified elements from the Proctor implementation outcomes framework: acceptability and fidelity of the video delivery. We performed content analysis on the notes taken from participants’ feedback to improve the video. Results: We recruited 129 participants (mean age of 59.4, SD 12.6 years) for this study. English was the preferred language (n=96, 74.4%) and Hindi was the predominant non-English language (n=17, 13.2%). Of the 129 participants enrolled, 128 completed follow-up immediately postintervention (1 lost interest). The average number of correct responses out of 10 was 5.4 (SD 2.7) at baseline and 7.2 (SD 2.5) postintervention (mean difference=1.9, 95% CI 1.6-2.2; P <.001; Cohen d _rm for paired change=0.72). The educational video was well-accepted, with 83.6% (107/128) of participants finding it easy to understand, 74.2% (95/128) engaging, and 87.5% (112/128) useful. Participants’ feedback for improvement highlighted content complexity and a preference for conversational language and dialects. Fidelity of the intervention was subjectively assessed as reasonably achieved, given that the core components of the intervention (ie, animations and educational content conveyed through the audio and subtitles) were delivered as intended. Fidelity of the implementation strategy was similarly assessed as reasonably achieved because there were no technology issues preventing delivery of the intervention as intended, through video display from a weblink embedded in REDCap, using a tablet with internet connection. Conclusions: A short educational video may improve patient knowledge of MI before discharge. Further scaled research is needed to evaluate the effectiveness and implementation of this intervention in additional languages and diverse populations. This study highlights the need for culturally and linguistically tailored resources in clinical settings, informing future research and policy on inclusive patient education.

Introduction: Atrial fibrillation (AF), a common arrhythmia, is associated with impaired quality of life (QoL) and increased stroke risk and mortality. Clinical guidelines recommend leveraging digital technologies to support patient education and AF self-management. Conversational artificial intelligence (AI) technologies may support patient engagement with self-management by enabling human-like conversations. This study aims to evaluate the effectiveness of a conversational AI intervention (Conversational HeAlth supporT in Atrial Fibrillation Self-Management - CHAT-AF-S) in improving QoL in patients with AF. Methods and analysis: CHAT-AF-S is a 3-month randomised controlled trial with 1:1 allocation and embedded process evaluation. We will randomise 480 adults (18 years of age and older) with documented AF to the CHAT-AF-S intervention or usual care. Primary outcome is the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) overall score. We will follow intention-to-treat principles and data analysts will be blinded. Intervention participants will be invited to complete a user experience survey and take part in an interview to explore the feasibility, acceptability, perceived utility, and barriers and enablers to implementing the intervention. Qualitative data will be analysed thematically. Ethics and dissemination: Ethics approval was obtained from the Western Sydney Local Health District Human Ethics Research Committee (2023/ETH00765). Written and informed consent will be obtained from all study participants before commencing any study procedures. Results will be disseminated via peer-reviewed publications and presentations at international conferences. Declaration of Interests: All investigators report nil conflicts of interest. Data Availability: The data that supports this project are available from the corresponding author upon reasonable request. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12623000850673 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386249

Background The impact of ketone supplementation, low carbohydrate diets (LCDs) and ketogenic diets (KDs) on heart failure (HF) outcomes is largely unknown. This systematic review and meta-analysis investigated how these dietary changes impacted cardiac function and HF outcomes. Method A systematic search of MEDLINE, Embase, CINAHL and Web of Science was performed; last search on 19 November 2025. Randomised controlled trials (RCTs) and observational studies in humans receiving ketone supplementation, LCD and KD interventions were included. Studies were eligible if they reported at least one cardiac function/HF measure. Risk of bias was performed using RoB2 and ROBINS-I (Risk Of Bias In Non-randomised Studies of Interventions). Treatment effects were pooled, mean differences and 95% CIs calculated. Subgroup analysis was performed and heterogeneity was assessed. Results 14 studies were included in this systematic review. A meta-analysis was performed on six RCTs. Ketone supplementation increased left ventricular ejection fraction by 3.12% (95% CI 0.95% to 5.30%, pConclusions Ketone supplementation significantly improved cardiac function compared with controls, especially in people with HFrEF. More research is needed to determine how low carbohydrate and ketogenic diets affect HF outcomes. PROSPERO registration number CRD42024615367.

BACKGROUND Multilingual videos deliver information across diverse preferred languages and literacy levels but the feasibility and impact on myocardial infarction (MI) knowledge of this approach during hospitalisation is unclear. OBJECTIVE To evaluate whether a multilingual educational video provided to hospitalised patients post-MI can feasibly improve patient knowledge of MI. METHODS We conducted an effectiveness-implementation hybrid quasi-experimental study from December 2023 to October 2024 in a tertiary hospital in Sydney, Australia. The intervention was a video on post-MI management, available in English, Arabic, Hindi and Mandarin. Primary outcome was change in patient knowledge of MI measured by comparing the mean number of correct responses before and immediately after the intervention using a two-sample t-test. We evaluated implementation as acceptability and fidelity of the video delivery. We performed thematic analysis on the notes taken of participants’ feedback for improving the video. RESULTS We recruited 129 participants (20.2% (26/129) female; mean age 59.4±12.6 years) English was the preferred language (74.4% (96/129)) and Hindi was the predominant non-English language (13.2%, 17/129). Average number of correct responses out of 10 increased from 5.4±2.7 at baseline to 7.2±2.5 post-intervention (mean difference = 1.9; 95% CI 1.6, 2.2, p<.001). The educational video was well-accepted, with 83.6% (107/128) of participants finding it easy to understand, 74.2% (95/128) engaging, and 87.5% (112/128) useful. We assessed fidelity of the intervention as high, as core components (i.e. animations and educational content via audio and subtitles) were delivered as intended. Participants’ feedback for improvement highlighted content complexity and a preference for conversational language and dialects. CONCLUSIONS A MI educational video delivered during inpatient admission, available in multiple languages, may improve patient knowledge in the short-term. Further scaled research is needed to evaluate the effectiveness and implementation of this intervention in additional languages and diverse populations. This study highlights the need for culturally and linguistically tailored resources in clinical settings, informing future research and policy on inclusive patient education. CLINICALTRIAL Not applicable

Background: International guidelines recommend that after a myocardial infarction (MI), patients receive education on key secondary prevention medications and lifestyle modifications, before hospital discharge. Multilingual videos may help deliver high-quality patient information to patients with diverse preferred languages and literacy levels, but little is known about the feasibility and impact on knowledge of this approach in the inpatient setting. To evaluate whether an educational video (available in English, Arabic, Hindi and Mandarin) provided to hospitalised patients post-MI can feasibly improve patient knowledge of MI. Methods: This was an effectiveness-implementation hybrid quasi-experimental study. Recruitment took place between December 2023 to October 2024 in a tertiary hospital in Sydney, Australia. The intervention consisted of a 5-minute educational video on post-MI management, available in English, Arabic, Hindi and Mandarin. The primary outcome was change in patient knowledge of MI measured by comparing the mean number of correct responses before and immediately after the intervention using a two-sample t-test. Implementation was assessed by evaluating the acceptability and fidelity of the video. We performed thematic analysis on the notes taken of participants’ feedback for improving the video. Results: Of the 129 participants recruited, 20.2% (26/129) were female and the mean age was 59.4 years (Standard deviation [SD] 12.6). For 74.4% (96/129) of participants English was their preferred language, with Hindi the predominant preferred non-English language (13.2%, 17/129). The average number of correct responses out of 10 at baseline was 5.4 (SD 2.7) compared to 7.2 (SD 2.5) post-intervention (mean difference = 1.9; 95% CI 1.6, 2.2, p<0.001). The educational video was well-accepted, with 83.6% (107/128) of participants finding it easy to understand, 74.2% (95/128) finding it engaging, and 87.5% (112/128) considering it useful. Fidelity of the intervention was assessed as high, as core components (i.e. animations and educational content via audio and subtitles) were delivered as intended. Themes from participants’ feedback for improvement include content complexity and preference for conversational language and dialects. Conclusion: A MI educational video delivered during inpatient hospital admission, available in multiple languages, may improve patient knowledge in the short term. Further scaled research is needed to evaluate the effectiveness and implementation of this intervention in other hospitals and settings, and to assess additional languages and strategies to support the health education needs of diverse populations.

Objectives: To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF.Study design: Systematic review and meta-analysis.Eligibility criteria: Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults with AF.Information sources: We searched MEDLINE, EMBASE and Scopus from 2005 to 2023.Risk-of-bias (RoB) assessment: We assessed RoB using the Cochrane Risk of Bias Tool 2 for RCTs and cluster RCT and the ROBINS-I tool for quasi-experimental studies.Synthesis of results: We used random effects meta-analysis to synthesise decisional conflict and patient knowledge outcomes reported in RCTs. We performed narrative synthesis for all outcomes. The main outcomes of interest were decisional conflict and patient knowledge.Results: 13 articles, reporting on 11 studies (4 RCTs, 1 cluster RCT and 6 quasi-experimental) met the inclusion criteria. There were 2714 participants across all studies (2372 in RCTs), of which 26% were women and the mean age was 71 years. Socioeconomically disadvantaged groups were poorly represented in the included studies. Seven studies (n=2508) focused on non-valvular AF and the mean CHAD2DS2-VASc across studies was 3.2 and for HAS-BLED 1.9. All tools focused on decisions regarding thromboembolic stroke prevention and most enabled calculation of individualised stroke risk. Tools were heterogeneous in features and functions; four tools were patient decision aids. The readability of content was reported in one study. Meta-analyses showed a reduction in decisional conflict (4 RCTs (n=2167); standardised mean difference −0.19; 95% CI −0.30 to –0.08; p=0.001; I²=26.5%; moderate certainty evidence) corresponding to a decrease in 12.4 units on a scale of 0 to 100 (95% CI −19.5 to –5.2) and improvement in patient knowledge (2 RCTs (n=1057); risk difference 0.72, 95% CI 0.68, 0.76, p2=0%; low certainty evidence) favouring digital patient decision-support tools compared with usual care. Four of the 11 tools were publicly available and 3 had been implemented in healthcare delivery.Conclusions: In the context of stroke prevention in AF, digital patient decision-support tools likely reduce decisional conflict and may result in little to no change in patient knowledge, compared with usual care. Future studies should leverage digital capabilities for increased personalisation and interactivity of the tools, with better consideration of health literacy and equity aspects. Additional robust trials and implementation studies are warranted.PROSPERO registration number: CRD42020218025

Purpose: Artificial intelligence (AI) for reading breast screening mammograms could potentially replace (some) human-reading and improve screening effectiveness. This systematic review aims to identify and quantify the types of AI errors to better understand the consequences of implementing this technology. Methods: Electronic databases were searched for external validation studies of the accuracy of AI algorithms in real-world screening mammograms. Descriptive synthesis was performed on error types and frequency. False negative proportions (FNP) and false positive proportions (FPP) were pooled within AI positivity thresholds using random-effects meta-analysis. Results: Seven retrospective studies (447,676 examinations; published 2019–2022) met inclusion criteria. Five studies reported AI error as false negatives or false positives. Pooled FPP decreased incrementally with increasing positivity threshold (71.83% [95% CI 69.67, 73.90] at Transpara 3 to 10.77% [95% CI 8.34, 13.79] at Transpara 9). Pooled FNP increased incrementally from 0.02% [95% CI 0.01, 0.03] (Transpara 3) to 0.12% [95% CI 0.06, 0.26] (Transpara 9), consistent with a trade-off with FPP. Heterogeneity within thresholds reflected algorithm version and completeness of the reference standard. Other forms of AI error were reported rarely (location error and technical error in one study each). Conclusion: AI errors are largely interpreted in the framework of test accuracy. FP and FN errors show expected variability not only by positivity threshold, but also by algorithm version and study quality. Reporting of other forms of AI errors is sparse, despite their potential implications for adoption of the technology. Considering broader types of AI error would add nuance to reporting that can inform inferences about AI’s utility.