Jonathan Nübel

Background: Atrial fibrillation (AF) is a major contributor of thromboembolic stroke. However, early detection remains challenging and is severely hindered by structural limitations in health care infrastructure. While current clinical guidelines recognize a 30-second single-lead electrocardiogram (ECG) as a standard diagnostic tool, the actual deployment and real-world utility of mobile screening technologies across health care settings remain poorly understood. Objective: The primary objective of this study was to evaluate the real-world feasibility of a mobile single-lead ECG for the detection of AF in routine inpatient and outpatient settings. Feasibility was evaluated by the proportion of successfully completed recordings, patient acceptance, and the occurrence and characteristics of technical challenges during deployment. Methods: This multicenter, cross-sectional pragmatic implementation study enrolled patients across 3 university hospitals and 3 primary care practices. Screening was performed using an US Food and Drug Administration (FDA)–approved single-lead ECG device (AliveCor KardiaMobile). Patients with an automated device reading indicating “Possible AF” and no prior diagnosis of AF underwent a confirmatory 12-lead ECG. Patient awareness and acceptance were evaluated using an exploratory, descriptive questionnaire. Results: A total of 237 patients were enrolled (194 inpatients and 43 outpatients). The device algorithm provided an automatic interpretation in 95.3% (41/43) of the outpatients and 85.6% (166/194) of inpatients, resulting in an overall automated detection of AF in 21.5% (51/237) of the cohort. The algorithm identified newly suspected AF in 1.7% (4/237) of patients without a prior AF diagnosis. Of these, 1 case underwent same-day confirmatory 12-lead ECG and was confirmed as AF. Technical challenges occurred in 16.0% (38/237) of all recordings, with a numerical higher rate observed in the inpatient setting (34/194, 17.5% vs 4/43, 9.3% in outpatients; P =.25). Only 6.3% (15/237) of patients reported regular use of telemedicine applications. Conclusions: Mobile single-lead ECG screening is feasible in routine inpatient and outpatient settings and identified a substantial prevalence of AF, which increased with age. The high detection rate underscores the potential of wearable ECG devices to facilitate early detection of AF. However, the absence of systematic confirmatory ECG testing and limited patient engagement with telemedicine applications highlight challenges in real-world implementation.

Objective: To describe the incidence, management, and outcomes of segmental and subsegmental pulmonary embolism (PE) in intensive care unit (ICU) patients and to explore associations between therapeutic-dose anticoagulation and clinical outcomes. Design: Single-center retrospective cohort study. Setting: Tertiary academic hospital ICU between January 2019 and June 2025. Patients: Critically ill adults (≥18 years) who underwent computed tomography pulmonary angiography (CTPA) during ICU admission and had radiologically confirmed segmental or subsegmental PE. Interventions: None. Measurements and main results: Radiology reports of all CTPA examinations performed in ICU-admitted patients were screened to identify the most proximal level of thrombus. Clinical records were reviewed for demographics, illness severity, radiologic characteristics, anticoagulation practice, bleeding, venous thromboembolism (VTE) recurrence, and mortality. Among 896 CTPA examinations performed in 804 patients, 164 examinations (18.3%) identified PE. Of these, 115 scans (12.8% of all CTPAs) demonstrated distal PE only, corresponding to 104 patients (12.9%) (61 segmental, 43 subsegmental). Overall, 96% of patients with distal PE received anticoagulation and 86% of anticoagulated patients received therapeutic-dose regimens. Bleeding occurred in 15% (major bleeding 12%), 90-day VTE recurrence in 7.8%, and 90-day mortality in 24%. No statistically significant association was found between the use of therapeutic-dose anticoagulation and 90-day mortality (adjusted odds ratio [OR], 0.70; 95% CI, 0.21–2.45), bleeding episodes (adjusted OR, 2.34; 95% CI, 0.47–19.2), or VTE recurrence (adjusted OR, 0.69; 95% CI, 0.11–6.22). Conclusions: In critically ill adults, segmental and subsegmental PE are commonly detected on CTPA and are usually treated with therapeutic-dose anticoagulation. Although VTE recurrence was less frequent than bleeding episodes and mortality, our study did not find a significant association between therapeutic-dose anticoagulation and bleeding episodes, recurrent VTE, or mortality. Larger prospective studies are needed to define optimal anticoagulation strategies for ICU patients with distal PE.

Background: Cardiovascular diseases remain a major health burden in Germany, and telemedicine (TM) offers promising solutions for outpatient care, yet barriers limit uptake. While prior studies relied on qualitative or conventional statistical methods, they often struggled with model uncertainty and complex relationships. Building on a national survey, this study applies Bayesian Model Averaging (BMA) and extreme gradient boosting (XGBoost). Objectives: This study aimed to explore candidate associations and patterns related to TM use among physicians in the German outpatient sector. Methods: We conducted a secondary analysis of a web-based survey carried out between 2023 and 2024. BMA was applied to identify explanatory associations with TM use, explicitly accounting for model uncertainty. XGBoost with SHAP values was used to explore classification patterns in a hypothesis-generating framework using repeated nested cross-validation. Results: Of the 165 respondents, 95 (58%) reported using TM. BMA revealed a limited number of variables with moderate to high posterior inclusion probabilities (PIP), alongside substantial overall model uncertainty, with TM use associated with receiving information from professional associations or insurers and perceived TM benefits (e.g., improving patients’ everyday quality of life, improving doctor-patient relationship). Practicing in Lower Saxony was associated with lower TM use. XGBoost demonstrated limited discriminative ability, with performance statistically indistinguishable from chance. SHAP-based analyses therefore identified exploratory patterns, including features such as information status, workplace, perceptions of TM’s benefits for patients (e.g., health literacy, compliance and adherence) and TM’s barriers (e.g., data protection, implementation incompatibility), as well as employment status. Conclusion: TM adoption in Germany’s outpatient sector appears associated with structural–economic factors and physicians’ perceptions of patient-related benefits. However, given the substantial model uncertainty in BMA and the limited predictive performance of the machine learning model, all findings should be interpreted cautiously. The machine learning component should be considered exploratory and hypothesis-generating.

Background: Semi-automated software is essential for planning and prosthesis selection prior transcatheter aortic valve replacement (TAVR). Reliable data on the usability of software programs for planning a TAVR is missing. The aim of this study was to compare software programs ‘Valve Assist 2’ (GE Healthcare) and 3mensio ‘Structural Heart’ (Pie Medical Imaging) regarding usability and accuracy of prosthesis size selection in program-inexperienced users. Methods: Thirty-one participants (n = 31) were recruited and divided into program-inexperienced users (beginners) (n = 22) and experts (n = 9). After software training, beginners evaluated 3 patient cases in 129 measurements (n = 129) using either Valve Assist 2 (n = 11) or Structural Heart (n = 11) on 2 test days (T1, T2). System Usability Scale (SUS) and ISONORM 9241/110-S (ISONORM) questionnaire were used after the test. The valve size selected by each beginner was compared with the valve size selected from expert group. Results: Valve Assist 2 had higher SUS Score: median 78.75 (25th, 75th percentile: 67.50, 85.00) compared to Structural Heart: median 65.00 (25th, 75th percentile: 47.50, 73.75), (p < 0,001, r = 0.557). Also, Valve Assist 2 showed a higher ISONORM score: median 1.05 (25th, 75th percentile: − 0.19, 1.71) compared to Structural Heart with a median 0.05 (25th, 75th percentile: − 0.49, 0.13), (p = 0.036, r = 0.454). Correctly selected valve sizes were stable over time using Valve Assist 2: 72.73% to 69.70% compared to Structural Heart program: 93.94% to 40% (χ² (1) = 21.10, p < 0.001, φ = 0.579). Conclusion: The study shows significant better usability scores for Valve Assist 2 compared to 3mensio Structural Heart in program-inexperienced users.

Background: In the coming years, telemedicine will play a key role in health care. Especially in rural areas with weak infrastructure, telemedicine could be crucial to providing adequate and personalized medical care. Objective: We investigated the acceptance and preferences of telemedicine among cardiologists, internists, and general practitioners. In addition, we aimed to identify knowledge, explore factors that influence the decision to adopt or reject this technology, and create starting points for demand-oriented further research. Methods: We conducted a web-based survey between May 2021 and February 2022. The 34-item questionnaire covered a wide range of questions regarding knowledge, acceptance, and use of telemedicine in cardiology care. Participants (cardiologists, internists, and general practitioners) were contacted through their professional email addresses, through a QR code published in a regional health journal, and through X (formerly known as Twitter). After exclusion of questionnaires with missed values, multidimensional scaling and k-means clustering were performed. Participants were divided into 3 clusters (C1, C2, and C3) based on their attitudes toward telecardiology. C1 uses telemedicine for personal health and clinical practice; C2 shows reluctance; C3 uses telemedicine mainly clinically. Results: We contacted 929 physicians. Of those 12.1% (112/929) completed the questionnaires. Participants were 56% male (54/97), 29% female (28/97), and 2% (2/97) diverse (median age 50 years). About 16% (18/112) of the respondents currently use telemedicine daily, 14.3% (16/112) 3-4 times a week, and 43% (48/112) did not use telemedicine at all. Overall, 35.1% (34/97) rated their knowledge of telemedicine as very good or good. Most of the respondents replied that telemedicine could support cardiology care in monitoring of blood pressure and electrocardiograms (57/97, 58.8%, both), consultation (57/97, 58.8%), and extending follow-up time (59/97, 60.8%). Reported barriers to implementation were mostly administration (26/97, 26.8%), inadequate reimbursement (25/97, 25.8%), and the purchase of technology equipment (23/97, 23.7%). Attitudes toward telemedicine in clinical practice were closely related to the number of patients being treated per annual quarter: C3 (median 1350, IQR 1000-1500) versus C1 (median 750, IQR 300-1200) and C2 (median 500, IQR 105-825). The differences between clinical caseloads of C1-C3 members were significant: C1 versus C2 (P=.03), C1 versus C3 (P=.02), and C2 versus C3 (P<.001). Most participants (87/112, 77.7%) would like to expand telemedicine approaches in the future. In the field of cardiology, the participants reported a high suitability of telemedicine. The willingness to train in telemedicine is high to very high for > 50% of the participants. Conclusions: Our results indicate generally moderate use but positive attitudes toward telemedicine among participating physicians with a higher clinical caseload. The lack of a structural framework seems to be a barrier to the effective implementation of telecardiology.