Sandra Prescher | Charité - Universitätsmedizin Berlin / Charité Medical University Berlin (original) (raw)
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Papers by Sandra Prescher
Studies in health technology and informatics, May 16, 2022
The demand for extended care for people suffering from heart failure is omnipresent. Wearables pr... more The demand for extended care for people suffering from heart failure is omnipresent. Wearables providing continuous heart rate measurement through optical sensors are of great interest due to their ease of use without the need for medical staff and their low cost. In this study, seven wearables were tested in fifteen measurement runs, with a duration of fourteen-hour each, and compared to a reference sensor. By calculating the Pearson correlation and the root mean square error, as well as the graphical representation by a Bland Altman plot, it was found that these wearables lack sufficient accuracy and may not be suitable for medical purposes.
2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), 2021
Heart failure is a serious disease which increases mortality as well as hospital admission rates ... more Heart failure is a serious disease which increases mortality as well as hospital admission rates for affected patients. Disease management programs supported by telehealth solutions are cost-effective approaches for reducing all-cause mortality and heart failure hospitalizations. A 6-minute walk test (6MWT) app could help heart failure patients to self-monitor their functional capacity. We have developed such an application capable of tracking the geolocation, guiding users through a 6MWT and providing the walked distance after six minutes. Besides common global navigation satellite system (GNSS) filtering methods like a Kalman filter, we have investigated the impact of positioning the device (tablet) and GNSS reception on the accuracy of the test. In a field experiment, we gathered 166 6MWT recordings with the developed mobile application. Applying the Kalman filter reduced the overall relative error from 35.5 % to 3.7 %. Wearing the tablet on the body led to significantly better results than holding it in the hand (p < .001). The average accuracy of 2.2 % of body-worn measurements was below previously defined thresholds for reliable results. It thus allows to define a procedure on how to perform and integrate an accurate 6MWT in telehealth settings for clinical decision support in heart failure patients.
Heart failure is a serious disease which increases mortality as well as hospital admission rates ... more Heart failure is a serious disease which increases mortality as well as hospital admission rates for affected patients. Disease management programs supported by telehealth solutions are cost-effective approaches for reducing all-cause mortality and heart failure hospitalizations. A 6-minute walk test (6MWT) app could help heart failure patients to selfmonitor their functional capacity. We have developed such an application capable of tracking the geolocation, guiding users through a 6MWT and providing the walked distance after six minutes. Besides common global navigation satellite system (GNSS) filtering methods like a Kalman filter, we have investigated the impact of positioning the device (tablet) and GNSS reception on the accuracy of the test. In a field experiment, we gathered 166 6MWT recordings with the developed mobile application. Applying the Kalman filter reduced the overall relative error from 35.5 % to 3.7 %. Wearing the tablet on the body led to significantly better re...
Hintergrund: In der Betreuung von Herzinsuffizienzpatienten werden zunehmend telemedizinische Anw... more Hintergrund: In der Betreuung von Herzinsuffizienzpatienten werden zunehmend telemedizinische Anwendungen eingesetzt. Das Telemonitoring bildet dabei eine Teilkomponente innerhalb eines holistischen Betreuungskonzeptes (Remote Patient Management), das die ambulante Präsenzbetreuung und Patientenschulung ergänzt. Die Rationale der telemedizinischen Mitbetreuung besteht insbesondere in der Früherkennung kardialer Funktionsverschlechterungen und daraus abgeleiteter frühzeitiger Intervention, um Hospitalisierungen zu vermeiden und Mortalität zu senken. In den vergangenen 15 Jahren wurden mehrere randomisierte, klinische Telemedizinstudien mit sehr uneinheitlichen Ergebnissen durchgeführt. Als eine der Hauptursachen wird die Adhärenz angesehen. Methode: Die eigenen Adhärenzuntersuchungen beziehen sich auf zwei randomisierte, klinische, nicht-invasive Telemedizinstudien mit Herzinsuffizienzpatienten im Stadium NYHA II/III. In den Jahren 2008 bis 2010 wurde die TIM-HF-Studie (Telemedical I...
KrV Kranken- und Pflegeversicherung, Jul 27, 2011
The Lancet Digital Health, 2019
Background The Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial showed t... more Background The Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial showed that, compared with usual care, a structured remote patient management (RPM) intervention done over 12-months reduced the percentage of days lost due to unplanned cardiovascular hospitalisations and all-cause death. The aim of the study was to evaluate whether this clinical benefit seen for the RPM group during the initial 12 month follow-up of the TIM-HF2 trial would be sustained 1 year after stopping the RPM intervention. Methods TIM-HF2 was a prospective, randomised, multicentre trial done in 43 hospitals, 60 cardiology practices, and 87 general practitioners in Germany. Patients with heart failure, New York Heart Association functional class II or III, and who had been hospitalised for heart failure within 12 months before randomisation were randomly assigned to either the RPM intervention or usual care. At the final study visit (main trial), the RPM intervention was stopped and the 1 year extended follow-up period started, which lasted 1 year. The primary outcome was percentage of days lost due to unplanned cardiovascular hospitalisations and all-cause mortality. Analyses were done using the intention-totreat principle. This trial is registered with ClinicalTrials.gov, number NCT01878630.
Der Internist, 2019
ZusammenfassungEine verbesserte ambulante Versorgung herzinsuffizienter Patienten wird als entsch... more ZusammenfassungEine verbesserte ambulante Versorgung herzinsuffizienter Patienten wird als entscheidend für das Bestreben angesehen, ungeplante kardiovaskuläre Hospitalisierungen zu vermeiden und die Mortalität zu senken. Eine zusätzliche Herausforderung besteht darin, regionale Unterschiede in der Herzinsuffizienzversorgung zwischen städtischen Regionen und ländlichen Gebieten auszugleichen. Für die Umsetzung dieser Ziele wird eine telemedizinische Mitbetreuung in Ergänzung zur ambulanten Präsenzmedizin von Haus- und Facharzt als relevant angesehen. In der vorliegenden Arbeit sollen die technischen und organisatorischen Grundlagen der telemedizinischen Arbeitsweise in der ambulanten Herzinsuffizienzbetreuung dargestellt werden. Zudem wird der aktuelle Evidenzstand zur Wirksamkeit einer telemedizinischen Mitbetreuung anhand der Studienergebnisse der 9 wichtigsten randomisierten Studien zur Telemedizin bei Herzinsuffizienz erläutert. Besondere Beachtung findet dabei die 2018 publizierte Studie TIM-HF2, in der die Überlegenheit einer telemedizinischen Mitbetreuung bezüglich Mortalität und Morbidität nach einer kürzlich stattgehabten Herzinsuffizienzhospitalisierung gezeigt werden konnte. Eine prästratifizierte Subgruppenanalyse zeigte keine signifikanten Interaktionen bezüglich des primären Endpunkts zwischen Metropolregionen und ländlichem Raum. Für die Translation des telemedizinischen Studienkonzepts von TIM-HF2 hin zu einem flächendeckenden Versorgungsangebot für alle Patienten in Deutschland bedarf es einer Skalierbarkeit. Telemed5000 ist ein erstes Projekt, das die Entwicklung eines Telemedizinzentrums zur telemedizinischen Mitbetreuung von bis zu 5000 Patienten unter Nutzung von künstlicher Intelligenz zum Ziel hat. Es wird vom Bundesministerium für Wirtschaft und Technologie im Zeitraum 2019–2022 gefördert.AbstractImproved outpatient care of heart failure patients is considered crucial to avoiding unplanned cardiovascular hospitalizations and reducing mortality. Making up for regional and rural differences in heart failure care poses a further challenge. Telemedical care as a supplement to outpatient point-of-care medicine by the general practitioner and medical specialist is considered relevant to implementing this goal. This article presents the technical and organizational basics of telemedical methods in outpatient heart failure care. Current evidence on the efficacy of telemedical co-management is also explained based on the results from the nine most important randomized studies on telemedicine in heart failure. Particular attention is paid to the TIM-HF2 study published in 2018, which showed the superiority of telemedical co-management in terms of mortality and morbidity following recent hospitalization for heart failure. Pre-stratified subgroup analysis revealed no significant interactions in terms of the primary endpoint between urban and rural regions. Scalability is required in order to translate the telemedical study concept from TIM-HF2 to a nationwide care program for all patients in Germany. Telemed5000 is the first project to set its goal as the development of a telemedicine center for the telemedical co-management of up to 5000 patients using artificial intelligence. It is being funded by the Federal Ministry of Economics and Technology for the period 2019–2022.
European Journal of Heart Failure, 2018
Heart failure (HF) is a complex, chronic condition that is associated with debilitating symptoms,... more Heart failure (HF) is a complex, chronic condition that is associated with debilitating symptoms, all of which necessitate close follow-up by health care providers. Lack of disease monitoring may result in increased mortality and more frequent hospital readmissions for decompensated HF. Remote patient management (RPM) in this patient population may help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a manifestation of HF decompensation.
The Lancet, 2018
Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2)
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2012
This paper describes the development, deployment and trial results from 9 volunteers using the eC... more This paper describes the development, deployment and trial results from 9 volunteers using the eCAALYX system. The eCAALYX system is an ambient assisted living telemonitoring system aimed at older adults suffering with co-morbidity. Described is a raw account of the challenges that exist and results in bringing a Telemedicine system from laboratory to real-world implementation and results for usability, functionality and reliability.
European Journal of Cardiovascular Nursing
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main fu... more Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research Background Remote Patient Management (RPM) enables early detection and prevention of cardiac deterioration in heart failure (HF) patients by measuring vital signs. Clinical trials reported inconsistent results. Patient adherence was suggested to be one of the main reasons for inconsistent results in previous trials (2-4). The "Telemedical interventional management in heart failure II (TIM-HF2)" study showed the superiority of non-invasive RPM compared to usual care (UC) in terms of mortality and unplanned cardiovascular (CV) hospitalisation (1). Purpose The objective of the analysis is to assess the patient experience with RPM, the adherence to daily measurements and outline factors affecting both aspects. Methods TIM-HF2 was conducted 2013-2018 with 1,538 HF patients in a 12-month follow-up (5). Inclusion crite...
Studies in health technology and informatics, May 16, 2022
The demand for extended care for people suffering from heart failure is omnipresent. Wearables pr... more The demand for extended care for people suffering from heart failure is omnipresent. Wearables providing continuous heart rate measurement through optical sensors are of great interest due to their ease of use without the need for medical staff and their low cost. In this study, seven wearables were tested in fifteen measurement runs, with a duration of fourteen-hour each, and compared to a reference sensor. By calculating the Pearson correlation and the root mean square error, as well as the graphical representation by a Bland Altman plot, it was found that these wearables lack sufficient accuracy and may not be suitable for medical purposes.
2021 43rd Annual International Conference of the IEEE Engineering in Medicine & Biology Society (EMBC), 2021
Heart failure is a serious disease which increases mortality as well as hospital admission rates ... more Heart failure is a serious disease which increases mortality as well as hospital admission rates for affected patients. Disease management programs supported by telehealth solutions are cost-effective approaches for reducing all-cause mortality and heart failure hospitalizations. A 6-minute walk test (6MWT) app could help heart failure patients to self-monitor their functional capacity. We have developed such an application capable of tracking the geolocation, guiding users through a 6MWT and providing the walked distance after six minutes. Besides common global navigation satellite system (GNSS) filtering methods like a Kalman filter, we have investigated the impact of positioning the device (tablet) and GNSS reception on the accuracy of the test. In a field experiment, we gathered 166 6MWT recordings with the developed mobile application. Applying the Kalman filter reduced the overall relative error from 35.5 % to 3.7 %. Wearing the tablet on the body led to significantly better results than holding it in the hand (p < .001). The average accuracy of 2.2 % of body-worn measurements was below previously defined thresholds for reliable results. It thus allows to define a procedure on how to perform and integrate an accurate 6MWT in telehealth settings for clinical decision support in heart failure patients.
Heart failure is a serious disease which increases mortality as well as hospital admission rates ... more Heart failure is a serious disease which increases mortality as well as hospital admission rates for affected patients. Disease management programs supported by telehealth solutions are cost-effective approaches for reducing all-cause mortality and heart failure hospitalizations. A 6-minute walk test (6MWT) app could help heart failure patients to selfmonitor their functional capacity. We have developed such an application capable of tracking the geolocation, guiding users through a 6MWT and providing the walked distance after six minutes. Besides common global navigation satellite system (GNSS) filtering methods like a Kalman filter, we have investigated the impact of positioning the device (tablet) and GNSS reception on the accuracy of the test. In a field experiment, we gathered 166 6MWT recordings with the developed mobile application. Applying the Kalman filter reduced the overall relative error from 35.5 % to 3.7 %. Wearing the tablet on the body led to significantly better re...
Hintergrund: In der Betreuung von Herzinsuffizienzpatienten werden zunehmend telemedizinische Anw... more Hintergrund: In der Betreuung von Herzinsuffizienzpatienten werden zunehmend telemedizinische Anwendungen eingesetzt. Das Telemonitoring bildet dabei eine Teilkomponente innerhalb eines holistischen Betreuungskonzeptes (Remote Patient Management), das die ambulante Präsenzbetreuung und Patientenschulung ergänzt. Die Rationale der telemedizinischen Mitbetreuung besteht insbesondere in der Früherkennung kardialer Funktionsverschlechterungen und daraus abgeleiteter frühzeitiger Intervention, um Hospitalisierungen zu vermeiden und Mortalität zu senken. In den vergangenen 15 Jahren wurden mehrere randomisierte, klinische Telemedizinstudien mit sehr uneinheitlichen Ergebnissen durchgeführt. Als eine der Hauptursachen wird die Adhärenz angesehen. Methode: Die eigenen Adhärenzuntersuchungen beziehen sich auf zwei randomisierte, klinische, nicht-invasive Telemedizinstudien mit Herzinsuffizienzpatienten im Stadium NYHA II/III. In den Jahren 2008 bis 2010 wurde die TIM-HF-Studie (Telemedical I...
KrV Kranken- und Pflegeversicherung, Jul 27, 2011
The Lancet Digital Health, 2019
Background The Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial showed t... more Background The Telemedical Interventional Management in Heart Failure II (TIM-HF2) trial showed that, compared with usual care, a structured remote patient management (RPM) intervention done over 12-months reduced the percentage of days lost due to unplanned cardiovascular hospitalisations and all-cause death. The aim of the study was to evaluate whether this clinical benefit seen for the RPM group during the initial 12 month follow-up of the TIM-HF2 trial would be sustained 1 year after stopping the RPM intervention. Methods TIM-HF2 was a prospective, randomised, multicentre trial done in 43 hospitals, 60 cardiology practices, and 87 general practitioners in Germany. Patients with heart failure, New York Heart Association functional class II or III, and who had been hospitalised for heart failure within 12 months before randomisation were randomly assigned to either the RPM intervention or usual care. At the final study visit (main trial), the RPM intervention was stopped and the 1 year extended follow-up period started, which lasted 1 year. The primary outcome was percentage of days lost due to unplanned cardiovascular hospitalisations and all-cause mortality. Analyses were done using the intention-totreat principle. This trial is registered with ClinicalTrials.gov, number NCT01878630.
Der Internist, 2019
ZusammenfassungEine verbesserte ambulante Versorgung herzinsuffizienter Patienten wird als entsch... more ZusammenfassungEine verbesserte ambulante Versorgung herzinsuffizienter Patienten wird als entscheidend für das Bestreben angesehen, ungeplante kardiovaskuläre Hospitalisierungen zu vermeiden und die Mortalität zu senken. Eine zusätzliche Herausforderung besteht darin, regionale Unterschiede in der Herzinsuffizienzversorgung zwischen städtischen Regionen und ländlichen Gebieten auszugleichen. Für die Umsetzung dieser Ziele wird eine telemedizinische Mitbetreuung in Ergänzung zur ambulanten Präsenzmedizin von Haus- und Facharzt als relevant angesehen. In der vorliegenden Arbeit sollen die technischen und organisatorischen Grundlagen der telemedizinischen Arbeitsweise in der ambulanten Herzinsuffizienzbetreuung dargestellt werden. Zudem wird der aktuelle Evidenzstand zur Wirksamkeit einer telemedizinischen Mitbetreuung anhand der Studienergebnisse der 9 wichtigsten randomisierten Studien zur Telemedizin bei Herzinsuffizienz erläutert. Besondere Beachtung findet dabei die 2018 publizierte Studie TIM-HF2, in der die Überlegenheit einer telemedizinischen Mitbetreuung bezüglich Mortalität und Morbidität nach einer kürzlich stattgehabten Herzinsuffizienzhospitalisierung gezeigt werden konnte. Eine prästratifizierte Subgruppenanalyse zeigte keine signifikanten Interaktionen bezüglich des primären Endpunkts zwischen Metropolregionen und ländlichem Raum. Für die Translation des telemedizinischen Studienkonzepts von TIM-HF2 hin zu einem flächendeckenden Versorgungsangebot für alle Patienten in Deutschland bedarf es einer Skalierbarkeit. Telemed5000 ist ein erstes Projekt, das die Entwicklung eines Telemedizinzentrums zur telemedizinischen Mitbetreuung von bis zu 5000 Patienten unter Nutzung von künstlicher Intelligenz zum Ziel hat. Es wird vom Bundesministerium für Wirtschaft und Technologie im Zeitraum 2019–2022 gefördert.AbstractImproved outpatient care of heart failure patients is considered crucial to avoiding unplanned cardiovascular hospitalizations and reducing mortality. Making up for regional and rural differences in heart failure care poses a further challenge. Telemedical care as a supplement to outpatient point-of-care medicine by the general practitioner and medical specialist is considered relevant to implementing this goal. This article presents the technical and organizational basics of telemedical methods in outpatient heart failure care. Current evidence on the efficacy of telemedical co-management is also explained based on the results from the nine most important randomized studies on telemedicine in heart failure. Particular attention is paid to the TIM-HF2 study published in 2018, which showed the superiority of telemedical co-management in terms of mortality and morbidity following recent hospitalization for heart failure. Pre-stratified subgroup analysis revealed no significant interactions in terms of the primary endpoint between urban and rural regions. Scalability is required in order to translate the telemedical study concept from TIM-HF2 to a nationwide care program for all patients in Germany. Telemed5000 is the first project to set its goal as the development of a telemedicine center for the telemedical co-management of up to 5000 patients using artificial intelligence. It is being funded by the Federal Ministry of Economics and Technology for the period 2019–2022.
European Journal of Heart Failure, 2018
Heart failure (HF) is a complex, chronic condition that is associated with debilitating symptoms,... more Heart failure (HF) is a complex, chronic condition that is associated with debilitating symptoms, all of which necessitate close follow-up by health care providers. Lack of disease monitoring may result in increased mortality and more frequent hospital readmissions for decompensated HF. Remote patient management (RPM) in this patient population may help to detect early signs and symptoms of cardiac decompensation, thus enabling a prompt initiation of the appropriate treatment and care before a manifestation of HF decompensation.
The Lancet, 2018
Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2)
Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2012
This paper describes the development, deployment and trial results from 9 volunteers using the eC... more This paper describes the development, deployment and trial results from 9 volunteers using the eCAALYX system. The eCAALYX system is an ambient assisted living telemonitoring system aimed at older adults suffering with co-morbidity. Described is a raw account of the challenges that exist and results in bringing a Telemedicine system from laboratory to real-world implementation and results for usability, functionality and reliability.
European Journal of Cardiovascular Nursing
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main fu... more Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research Background Remote Patient Management (RPM) enables early detection and prevention of cardiac deterioration in heart failure (HF) patients by measuring vital signs. Clinical trials reported inconsistent results. Patient adherence was suggested to be one of the main reasons for inconsistent results in previous trials (2-4). The "Telemedical interventional management in heart failure II (TIM-HF2)" study showed the superiority of non-invasive RPM compared to usual care (UC) in terms of mortality and unplanned cardiovascular (CV) hospitalisation (1). Purpose The objective of the analysis is to assess the patient experience with RPM, the adherence to daily measurements and outline factors affecting both aspects. Methods TIM-HF2 was conducted 2013-2018 with 1,538 HF patients in a 12-month follow-up (5). Inclusion crite...