{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T01:40:27Z","timestamp":1758591627755,"version":"3.44.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T00:00:00Z","timestamp":1754265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009398","name":"Medical Faculty of RWTH Aachen University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009398","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Recurrent congestive episodes are a primary cause of hospitalizations in patients with heart failure. Hitherto, outpatient management adopts a reactive approach, assessing patients clinically through frequent follow-up visits to detect congestion early. This study aims to assess the capabilities of a self-supervised contrastive learning-derived risk index to detect episodes of acute decompensated heart failure (ADHF) in patients using continuously recorded wearable time-series data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This is the protocol for a single-arm, prospective cohort pilot study that will include 290 patients with ADHF. Acute decompensated heart failure is diagnosed by clinical signs and symptoms, as well as additional diagnostics (e.g. NT-proBNP). Patients will receive standard-of-care treatment, supplemented by continuous wearable-based monitoring of vital signs and physical activity, and are followed for 90 days. During follow-up, study visits will be conducted and presentations without clinical ADHF will be referred to as \u2018regular\u2019 and data from these episodes will be presented to a deep neural network that is trained by a self-supervised contrastive learning objective to extract features from the time-series that are typical in regular periods. The model is used to calculate a risk index measuring the dissimilarity of observed features from those of regular periods. The primary outcome of this study will be the risk index\u2019s accuracy in detecting episodes with ADHF. As secondary outcome data integrity and the score in the validated questionnaire System Usability Scale will be evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Demonstrating reliable congestion detection through continuous monitoring with a wearable and self-supervised contrastive learning could assist in pre-emptive heart failure management in clinical care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical trial registration<\/jats:title>\n                  <jats:p>The study was registered in the German clinical trials register (DRKS00034502).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjdh\/ztaf004","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T15:16:41Z","timestamp":1737472601000},"page":"1076-1083","source":"Crossref","is-referenced-by-count":0,"title":["Congestion assessment using a self-supervised contrastive learning-derived risk index in patients with congestive heart failure (CONAN): protocol and design of a prospective cohort study"],"prefix":"10.1093","volume":"6","author":[{"given":"Bojan","family":"Hartmann","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels-Ulrik","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1141-1126","authenticated-orcid":false,"given":"Julia","family":"Brandts","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3361-3722","authenticated-orcid":false,"given":"Marlo","family":"Verket","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6141-634X","authenticated-orcid":false,"given":"Nikolaus","family":"Marx","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niveditha","family":"Dinesh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Schuetze","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna Emilia","family":"Pape","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"M\u00fcller-Wieland","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Kollmann","sequence":"additional","affiliation":[{"name":"Department of Biology, Heinrich Heine University D\u00fcsseldorf , D\u00fcsseldorf 40225 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Marx-Sch\u00fctt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Puetz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Michels","sequence":"additional","affiliation":[{"name":"Department of Biology, Heinrich Heine University D\u00fcsseldorf , D\u00fcsseldorf 40225 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca Leon","family":"Happel","sequence":"additional","affiliation":[{"name":"Department of Haematology, Oncology, and Clinical Immunology, Medical Faculty, University Hospital D\u00fcsseldorf, Heinrich Heine University D\u00fcsseldorf , D\u00fcsseldorf 40225 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Haematology, Oncology, and Clinical Immunology, Medical Faculty, University Hospital D\u00fcsseldorf, Heinrich Heine University D\u00fcsseldorf , D\u00fcsseldorf 40225 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Kobbe","sequence":"additional","affiliation":[{"name":"Department of Haematology, Oncology, and Clinical Immunology, Medical Faculty, University Hospital D\u00fcsseldorf, Heinrich Heine University D\u00fcsseldorf , D\u00fcsseldorf 40225 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0780-0003","authenticated-orcid":false,"given":"Malte","family":"Jacobsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Medical Faculty, RWTH Aachen University , Pauwelsstra\u00dfe 30, Aachen 52074 ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,4]]},"reference":[{"key":"2025092119530062000_ztaf004-B1","doi-asserted-by":"crossref","first-page":"2546","DOI":"10.1002\/ehf2.13407","article-title":"Hospitalizations for heart failure: still major differences between East and West Germany 30 years after reunification","volume":"8","author":"Dorr","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2025092119530062000_ztaf004-B2","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1016\/j.ejheart.2008.09.008","article-title":"Pharmacotherapy according to treatment guidelines is associated with lower mortality in a community-based sample of patients with chronic heart failure: a prospective cohort study","volume":"10","author":"Stork","year":"2008","journal-title":"Eur J Heart Fail"},{"key":"2025092119530062000_ztaf004-B3","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1002\/ehf2.12792","article-title":"Recurrent hospitalizations are associated with increased mortality across the ejection fraction range in heart failure","volume":"7","author":"Huusko","year":"2020","journal-title":"ESC Heart Fail"},{"key":"2025092119530062000_ztaf004-B4","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jacc.2012.09.038","article-title":"Rehospitalization for heart failure: problems and perspectives","volume":"61","author":"Gheorghiade","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2025092119530062000_ztaf004-B5","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1002\/ejhf.1492","article-title":"Acute heart failure congestion and perfusion status\u2014impact of the clinical classification on in-hospital and long-term outcomes; insights from the ESC-EORP-HFA Heart Failure Long-Term Registry","volume":"21","author":"Chioncel","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2025092119530062000_ztaf004-B6","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1001\/archinte.168.8.847","article-title":"Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF","volume":"168","author":"Fonarow","year":"2008","journal-title":"Arch Intern Med"},{"key":"2025092119530062000_ztaf004-B7","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1038\/s41569-020-0379-7","article-title":"Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment","volume":"17","author":"Boorsma","year":"2020","journal-title":"Nat Rev Cardiol"},{"key":"2025092119530062000_ztaf004-B8","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1016\/j.cardfail.2016.06.422","article-title":"What are effective program characteristics of self-management interventions in patients with heart failure? An individual patient data meta-analysis","volume":"22","author":"Jonkman","year":"2016","journal-title":"J Card Fail"},{"key":"2025092119530062000_ztaf004-B9","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/S0140-6736(22)02076-1","article-title":"Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF): a multinational, open-label, randomised, trial","volume":"400","author":"Mebazaa","year":"2022","journal-title":"Lancet"},{"key":"2025092119530062000_ztaf004-B10","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/eurjhf\/hfq045","article-title":"Assessing and grading congestion in acute heart failure: a scientific statement from the Acute Heart Failure Committee of the Heart Failure Association of the European Society of Cardiology and endorsed by the European Society of Intensive Care Medicine","volume":"12","author":"Gheorghiade","year":"2010","journal-title":"Eur J Heart Fail"},{"key":"2025092119530062000_ztaf004-B11","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s11897-022-00548-z","article-title":"Digital technologies to support better outcome and experience of care in patients with heart failure","volume":"19","author":"McBeath","year":"2022","journal-title":"Curr Heart Fail Rep"},{"key":"2025092119530062000_ztaf004-B12","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1002\/ejhf.1943","article-title":"Pulmonary artery pressure-guided therapy in ambulatory patients with symptomatic heart failure: the CardioMEMS European Monitoring Study for Heart Failure (MEMS-HF)","volume":"22","author":"Angermann","year":"2020","journal-title":"Eur J Heart Fail"},{"key":"2025092119530062000_ztaf004-B13","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.ijcard.2017.02.120","article-title":"Evaluation of remote dielectric sensing (ReDS) technology-guided therapy for decreasing heart failure re-hospitalizations","volume":"240","author":"Amir","year":"2017","journal-title":"Int J Cardiol"},{"key":"2025092119530062000_ztaf004-B14","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1177\/1932296820904947","article-title":"Noninvasive continuous monitoring of vital signs with wearables: fit for medical use?","volume":"15","author":"Jacobsen","year":"2020","journal-title":"J Diabetes Sci Technol"},{"key":"2025092119530062000_ztaf004-B15","doi-asserted-by":"crossref","first-page":"e006513","DOI":"10.1161\/CIRCHEARTFAILURE.119.006513","article-title":"Continuous wearable monitoring analytics predict heart failure hospitalization: the LINK-HF multicenter study","volume":"13","author":"Stehlik","year":"2020","journal-title":"Circ Heart Fail"},{"key":"2025092119530062000_ztaf004-B16","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1038\/s41746-023-00847-2","article-title":"Wearable based monitoring and self-supervised contrastive learning detect clinical complications during treatment of hematologic malignancies","volume":"6","author":"Jacobsen","year":"2023","journal-title":"NPJ Digit Med"},{"key":"2025092119530062000_ztaf004-B17","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1002\/ejhf.1369","article-title":"The use of diuretics in heart failure with congestion\u2014a position statement from the Heart Failure Association of the European Society of Cardiology","volume":"21","author":"Mullens","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2025092119530062000_ztaf004-B18","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1001\/jama.297.12.1332","article-title":"Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST clinical status trials","volume":"297","author":"Gheorghiade","year":"2007","journal-title":"JAMA"},{"key":"2025092119530062000_ztaf004-B19","doi-asserted-by":"crossref","first-page":"e14479","DOI":"10.2196\/14479","article-title":"The German version of the mobile app rating scale (MARS-G): development and validation study","volume":"8","author":"Messner","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"2025092119530062000_ztaf004-B20","first-page":"96","article-title":"Comparison of German translations of the system usability scale\u2014which to take?","volume":"307","author":"Brix","year":"2023","journal-title":"Stud Health Technol Inform"},{"key":"2025092119530062000_ztaf004-B21"},{"author":"Narayanswamy","key":"2025092119530062000_ztaf004-B22","doi-asserted-by":"publisher","DOI":"10.48550\/arXiv.2410.13638"}],"container-title":["European Heart Journal - Digital Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjdh\/advance-article-pdf\/doi\/10.1093\/ehjdh\/ztaf004\/63928620\/ztaf004.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjdh\/article-pdf\/6\/5\/1076\/63928620\/ztaf004.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjdh\/article-pdf\/6\/5\/1076\/63928620\/ztaf004.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T23:53:10Z","timestamp":1758498790000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjdh\/article\/6\/5\/1076\/8221836"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,4]]},"references-count":22,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,8,4]]},"published-print":{"date-parts":[[2025,9,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjdh\/ztaf004","relation":{},"ISSN":["2634-3916"],"issn-type":[{"type":"electronic","value":"2634-3916"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,8,4]]}}}