A randomized prospective open-label controlled trial comparing the performance of a connected monitoring interface versus physical routine monitoring in patients with rheumatoid arthritis.

OBJECTIVES: In RA, telemedicine may allow tight control of disease activity while reducing hospital visits. We developed a smartphone application connected with a physician's interface to monitor RA patients. We aimed to assess the performance of this e-Health solution in comparison with routine practice in the management of patients with RA. METHODS: A six-month pragmatic, randomized, controlled, prospective, clinical trial was conducted in RA patients with high to moderate disease activity starting a new DMARD therapy. Two groups were established: 'connected monitoring' and 'conventional monitoring'. The primary outcome was the number of physical visits between baseline and six months. Secondary outcomes included adherence, satisfaction, changes in clinical, functional and health status scores (Short-Form 12). RESULTS: Of the 94 randomized patients, 89 completed study: 44 in the 'conventional monitoring' arm and 45 in the 'connected monitoring' arm. The total number of physical visits between required baseline and six-month visits was significantly lower in the 'connected monitoring' group [0.42 (0.58) vs 1.93 (0.55); P <0.05]. No differences between groups were observed in the clinical and functional scores. A better quality of life for Short-Form 12 subscores (Role-Physical and Role-Emotional) were found in the 'connected monitoring' group. CONCLUSION: Our results suggest that connected monitoring reduces the number of physical visits while maintaining a tight control of disease activity and improving quality of life in patients with RA starting a new treatment. TRIAL REGISTRATION: ClinicalTrials.gov, https://clinicaltrials.gov, NCT03005925.

Prognostic value of 24-hour ambulatory blood pressure measurement for the onset of atrial fibrillation in treated patients with essential hypertension.

This study retrospectively determined the prognostic variables of blood pressure by 24-hour ambulatory blood pressure measurement in relation to onset of atrial fibrillation in treated patients who had essential hypertension and analyzed the class effect of antihypertensive management on the nonoccurrence of this supraventricular arrhythmia.

Prognostic value of dobutamine echocardiography in patients with intermediate coronary lesions at angiography.

UNLABELLED: The prognostic value of dobutamine echocardiography (DOBU-ECHO) in patients with intermediate coronary lesions has not been described in the literature. The aim of this study was to determine the prognostic value of DOBU-ECHO in patients presenting with coronary lesions smaller than 50% at angiography. Ninety-four consecutive patients were analyzed and followed-up for 64 +/- 7 months (range: 12 to 75 months). All patients presented with coronary lesions between >or= 30% and < 50% of the luminal diameter of at least one major epicardial vessel. The patient population was divided into two groups: Those with a positive DOBU-ECHO (n = 23) and those with a negative DOBU-ECHO (n = 71). The number of coronary lesions did not differ between the two groups. The patients with a positive DOBU-ECHO result were more likely than those in the negative group to have a family history of coronary artery disease or suffer from hypertension or a dyslipidemia. During the follow-up period, 13 cardiac events occurred (1 cardiac death, 5 myocardial infarctions, 2 unstable anginas, and 5 myocardial revascularizations), 11 (47.8%) of which occurred in patients with positive DOBU-ECHO. The annual incidence for a cardiac event was 7.9% per year in the positive DOBU-ECHO group and 0.5% per year in the negative DOBU-ECHO group (P < 0.001). This incidence remained significant for spontaneous cardiac events, such as cardiac death, myocardial infarction, and unstable angina (5.8% per year vs 0.2% per year; P < 0.001). CONCLUSIONS: In patients with angiographically confirmed intermediate coronary lesions, a positive DOBU-ECHO is an additional risk factor for the onset of a cardiac event, whereas a negative DOBU-ECHO can be used to define patients with a low cardiac risk.

Atrial tachycardia with recipient-to-donor atrioatrial conduction and isthmus-dependent donor atrial flutter in a patient after orthotopic heart transplantation. Successful treatment by radiofrequency catheter ablation.

Atrial arrhythmias are common after orthotopic heart transplantation. We report an unusual case of a patient after heart transplantation with 2 types of atrial arrhythmias: one was a macro-reentrant, incisional, recipient-atrial tachycardia conducted to the donor atrium, and the other was a common-type, isthmus-dependent atrial flutter in the donor atrium. These 2 arrhythmias were successfully treated with selective radiofrequency catheter ablation.