Paul Dendale

• Professor (Associate) at Hasselt University

Introduction Cardiovascular and physical deconditioning are common in breast cancer patients undergoing chemotherapy, which can impact functional ability and quality of life (QoL). Physical activity interventions have shown promise in improving these outcomes. However, the impact of telerehabilitation during and after chemotherapy is not known. Pu...

Background Nutritional management is essential in cardiac rehabilitation, particularly for dietary monitoring, as obesity is a major cardiovascular risk factor. Digital health solutions, such as smart diet applications, hold potential to improve dietary habits and weight management in patients with cardiovascular disease (CVD). This study evaluated...

The use of respectful communication is essential to establishing a good therapeutic relationship between the healthcare professional (HCP) and the patient. Negative language can adversely affect interactions between the public and HCPs. Person-centred care is advocated in cardiovascular care, but there is lack of information regarding on how commun...

Aims Trials on integrated care for atrial fibrillation (AF) showed mixed results in different AF populations using various approaches. The multicentre, randomized AF-EduCare trial evaluated the effect of targeted patient education on unplanned cardiovascular outcomes. Methods and results Patients willing to participate were randomly assigned to in...

Background Physical activity plays a crucial role in cardiac rehabilitation for secondary prevention. Despite its importance, participation rates in cardiac rehabilitation programs remain low. Telemedicine, particularly telerehabilitation, presents a viable solution by offering remote access to cardiac rehabilitation services. This innovative appro...

Background Obstructive sleep apnea (OSA) is a common, yet underdiagnosed risk factor in atrial fibrillation (AF) patients. Polysomnography (PSG) is the gold standard for OSA diagnosis but is also costly, time-consuming, and labor-intensive. (Cardio)-respiratory polygraphy (PG) offers an ambulatory screening for OSA detection. Studying the impact of...

Aims Although electrical activity of the normal human heart is well characterized by the electrocardiogram, detailed insights into within-subject and between-subject variations of ventricular activation and recovery by noninvasive electroanatomic mapping are lacking. We characterized human epicardial activation and recovery within and between norma...

Background Cardiac telerehabilitation is proven to be equally safe and effective as center-based cardiac rehabilitation. Nevertheless, some real-world barriers significantly impact the adoption and successful implementation of cardiac rehabilitation as well as cardiac telerehabilitation. Purpose This study assesses willingness and actual participa...

Background/Introduction Remote training has demonstrated effectiveness in multiple trials. Implementation trials are the next step to achieve this as standard of care. Purpose The pilot study is a next step in our centre’s road towards implementation of cardiac rehabilitation. It is performed in a relatively young, obese population without known c...

Background Digital health has been increasingly applied to the cardiovascular field, especially since the COVID era. Japan is a super-aged society with an average life expectancy of 81 years for men and 87 years for women in 2023. However, there are no existing tools to measure digital health readiness and learnability to implement "digital cardiol...

Background Physical activity is a key component of cardiac rehabilitation. However, inclusion rates in cardiac rehabilitation programs remain low and patients currently have only limited input in their exercise prescription. SharedHeart is a digitally-supported shared decision making approach that assists patients with heart disease and their careg...

Mobile health (mHealth) solutions have the potential to improve self-management and clinical care. For successful integration into routine clinical practice, healthcare professionals (HCPs) need accepted criteria helping the mHealth solutions’ selection, while patients require transparency to trust their use. Information about their evidence, safet...

Background Although pulmonary vein isolation (PVI) is an extensively utilized atrial fibrillation (AF) treatment, many patients still experience AF recurrences. Multimorbidity care, including physical activity, may reduce recurrences. In Belgium, patients undergoing an ablation are entitled to a cardiac rehabilitation (CR) program after PVI, but no...

Background and aims Although electrical activity of the normal human heart is well-characterized by the 12-lead electrocardiogram, detailed insights into within-subject and between-subject variations of ventricular activation and recovery by noninvasive electroanatomic mapping are lacking. We characterized human epicardial activation and recovery w...

Introduction ICD-codes are used for classification of hospitalisations. The codes are used for administrative, financial and research purposes. It is known however that errors occur. Natural language processing (NLP) offers promising solutions for optimising the process. Objectives To investigate methods for automatic classification of disease in...

The use and promotion of active transportation has been scientifically proven to play a fundamental role in influencing global sustainable development goals. Despite increased recognition, there is a notable gap in understanding how to effectively transition the general population from convenience-oriented transport to embracing active modes. The a...

Introduction Digital health has the potential to support health care in rural areas by overcoming the problems of distance and poor infrastructure, however, rural areas have extremely low use of digital health because of the lack of interaction with technology. There is no existing tool to measure digital health literacy in rural China. This study...

Background: Physical activity is a key component of cardiac rehabilitation. However, EUROASPIRE V concluded that intending 48% of coronary artery disease (CAD) patients do not intend to do physical activity in the next six months. Patient involvement improves patient satisfaction, adherence, and health outcomes and is a prerequisite for good clinic...

Multidisciplinary cardiac rehabilitation (CR) improves the prognosis and quality of life of patients with cardiovascular disease and has therefore received strong recommendations in international guidelines for the treatment of patients with chronic coronary syndromes and chronic heart failure. Aiming to both resolve several barriers that impede pa...

Introduction Treatment with oral anticoagulation (OAC) is one of the main pillars in managing atrial fibrillation (AF). Education and intake monitoring are recommended to improve therapy adherence to OAC. Over the past few years, the importance of smart devices has increased, opening up new potential for patient education and better patient follow-...

Introduction A multidisciplinary approach is needed for the management of atrial fibrillation (AF) in which the patient has a central role. Smart devices create opportunities to improve AF management. This paper aimed to evaluate the in-house developed AF-EduApp application on its usability, satisfaction, and communication effectiveness with the ca...

Lifestyle optimization is one of the most essential components of cardiovascular disease prevention. Motivational counseling provided by health care professionals could promote lifestyle modification. The purpose of the review is to identify possible evidence-based psychological principles that may be applicable to motivational counseling in the pr...

Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and t...

In Europe alone, on a yearly basis millions of people need an appropriate exercise prescription to prevent the occurrence or progression of cardiovascular disease (CVD). A general exercise recommendation can be provided to these individuals (at least 150 min of moderate-intensity endurance exercise, spread over 3-5 days/week, complemented by dynami...

Secondary prevention is recommended after a cardiac event to stimulate recovery and reduce the risk of recurrent events. To optimize the results and support the patients to actively play a part in the prevention programme, the European guidelines and EAPC position statements on prevention of cardiovascular diseases suggest a holistic approach and s...

Aims: Heart failure (HF) is a common cause of mortality and (re)hospitalisations. The NWE-Chance project explored the feasibility of providing hospitalisations at home (HH) supported by a newly developed digital health platform. The aim of this study was to explore the perceived usability by healthcare professionals (HCPs) of a digital platform in...

Background As the prevalence of atrial fibrillation (AF) increases worldwide and AF management becomes ever more diversified and personalised, insights into (regional) AF patient demographics and contemporary AF management are needed. This paper reports the current AF management and baseline demographics of a Belgian AF population recruited for a l...

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWO - Flanders Research Foundation. Background/Introduction The international classification of disease (ICD) codes are used worldwide for classification of hospitalisations. The codes are used for administrative, financial and researc...

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Background Obstructive sleep apnea (OSA) is...

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Daiichi-Sankyo, Inc. Background In secondary prevention of coronary artery disease (CAD), nutritional management is an integral part of lifestyle optimization. While face-to-face nutritional follow-up is part of standard of care in many centres, few studies...

Funding Acknowledgements Type of funding sources: None. Background Telemonitoring is an intervention that has shown to improve care of heart failure (HF) patients and thus plays a major role in preventing frequent hospital visits. Purpose This study examined the impact of HF telemonitoring on unplanned hospitalization. Methods Patients admitted...

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This study is part of Limburg Clinical Research Center, supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital. Background Many cardiovascular patients are only seen by a...

Introduction Many patients with cardiovascular diseases are only seen by a physician once or twice a year unless urgent symptoms. Recent years have shown an increase in digital technologies to follow patients remotely, that is, telemedicine. Telemedicine can be supportive for follow-up of patients at continuous risk. This study investigated patient...

Background: The optimal way to determine repolarization time (RT) from the intracardiac unipolar electrogram (UEG) has been a topic of debate for decades. RT is typically determined by either the Wyatt method or the “alternative method,” which both consider UEG T-wave slope, but differently. Objective: To determine the optimal method to measure RT...

The American College of Sports Medicine determined the energy consumption of daily activities and sports. Cardiac telerehabilitation (CTR) requires knowing how much energy people consume in daily life outside of cardiac rehabilitation activities. Therefore, we have investigated if the estimated values are valid in CTR. Data from two studies were in...

Objective: In a secondary prevention of coronary artery disease (CAD), nutritional management is an integral part of lifestyle optimisation. However, few studies have investigated the potential of remote nutritional follow-up using digital solutions. This study investigates the effectiveness of a smartphone application for nutrition education and f...

Background: Participation rates in cardiac rehabilitation (CR) are low. In multiple trials, telerehabilitation (TR) has been demonstrated to be effective. Still, real-life evidence is scarce. During the first surge of the COVID-19 pandemic our centre deployed a TR programme. This study aimed to characterise the patient population that had, for the...

Introduction: Despite proven benefits, patients with coronary heart disease (CHD) typically fail to participate in sufficient physical activity (PA). Effective interventions should be implemented to help patients maintain a healthy lifestyle and modify their present behavior. Gamification is the use of game design features (such as points, leaderb...

Aims: The aim of this study was to provide an up-to-date overview of gender differences or similarities in risk factor control and medical management in the Belgian CHD population. Methods: All analyses are based on the ESC EORP EUROASPIRE IV and EUROASPIRE V (European Survey Of Cardiovascular Disease Prevention And Diabetes) surveys. Patients b...

Background Hospitalisations for heart failure are frequent and costly, linked with a lower quality of life, and lead to higher morbidity and mortality. Home hospitalisation interventions could be a substitute for in-hospital stays to reduce the burden on patients. The current study aims to investigate patient-reported satisfaction and usability in...

Background The management of atrial fibrillation (AF) is complex and based on three main pillars: avoid stroke, better symptom control and cardiovascular risk factor management. Therefore, a holistic, multidisciplinary approach is needed in which the patient has a central role. Smartphone ownership increases strongly in the elderly population (in B...

Background The management of atrial fibrillation (AF) is complex and based on three main pillars: avoid stroke, better symptom control and cardiovascular risk factor management. Therefore, a holistic, multidisciplinary approach is needed in which the patient has a central role. Smartphone ownership increases strongly in the elderly population (in B...

Background Atrial fibrillation (AF) has a complex treatment strategy. As stated in the recent guidelines for AF management, AF management requires a holistic and multidisciplinary approach in which a personalized follow-up strategy is important to involve patients in their care. This also includes the need for an improved communication method in wh...

Physical activity (PA) plays an essential part in the secondary prevention of persons with coronary heart disease (CHD). A substantial amount of PA can be gained through increasing the use of active transport modes (walking or cycling for at least 10 min/day) in CHD patients’ daily routine, benefiting the mortality and morbidity rate as well as the...

Aims Home blood pressure monitoring (HBPT) is a useful way to manage BP. Recent advances in digital technology to automatically transmit BP data without the patient input may change the approach to long-term BP treatment and follow-up. The purpose of this review is to summarize the latest data on the HBPT with automatic data transmission. Methods...

Background Non-vitamin K antagonist oral anticoagulants (NOACs) are the preferred choice of anticoagulants to prevent stroke in most patients with atrial fibrillation (AF). NOAC's dosing algorithms are defined in the respective Summary of Product Characteristics (SmPC) but the European Heart Rhythm Association (EHRA) Practical Guide can also be use...

BACKGROUND Multiple questionnaires exist to assess digital literacy. However, participation and adherence to digital health interventions is linked with other factors such as digital skills and access. OBJECTIVE The aim of the development of the Digital Health Readiness-Q (DHR-Q) was to create a short, usable, and freely accessible questionnaire t...

Background While questionnaires for assessing digital literacy exist, there is still a need for an easy-to-use and implementable questionnaire for assessing digital readiness in a broader sense. Additionally, learnability should be assessed to identify those patients who need additional training to use digital tools in a health care setting. Objec...

Aim To compare the cardiac function and pulmonary vascular function during exercise between dyspneic and non-dyspneic patients with type 2 diabetes mellitus (T2DM). Methods 47 T2DM patients with unexplained dyspnea and 50 asymptomatic T2DM patients underwent exercise echocardiography combined with ergospirometry. Left ventricular (LV) function (st...

Aims Depression and anxiety have a detrimental effect on the health outcomes of patients with heart disease. Digital health interventions (DHIs) could offer a solution to treat depression and anxiety in patients with heart disease, but evidence of its efficacy remains scarce. This review summarises the latest data about the impact of DHIs on depres...

Background Novel smartwatch-based cuffless blood pressure (BP) measuring devices are coming to market and receive FDA and CE labels. These devices are often insufficiently validated for clinical use. This study aims to investigate a recently CE-cleared smartwatch using cuffless BP measurement in a population with normotensive and hypertensive indiv...

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The AF-EduCare study is a project supported by the Fund for Scientific Research, Flanders (T002917N). The AF-EduApp study is supported by an BMS/Pfizer European Thrombosis Investigator Initiated Research Program (ERISTA) grant. Background Atrial fibrillation (AF) is a...

Type 1 diabetes mellitus (T1DM) has an important impact on morbidity and mortality because it may start early in life. Therefore, the early detection of cardiovascular autonomic neuropathy (DCAN) in T1DM patients is important to intervene quickly and prevent further deterioration. Traditional autonomic function tests detect abnormalities in severel...

Patients suffering from coronary heart disease (CHD) require to attend cardiac rehabilitation to manage modifiable risk factors including physical activity (PA) to avoid the progression of the disease. However, attendance in these programs is low. Travel-related PA (TPA) monitoring via a smartphone app can provide an opportunity to assess the part...

Background: To evaluate the diagnostic accuracy of semi-quantitative adenosine perfusion magnetic resonance imaging (MRI) to determine fractional flow reserve (FFR) ≤ 0.80 intermediate-grade coronary stenoses as compared to visual analysis. Methods: Forty-six patients (mean age 61 ± 9 years; 33 males) with 49 intermediate-grade stenoses (59 ± 7....

Exercise training is highly recommended in current guidelines on primary and secondary prevention of cardiovascular disease (CVD). This is based on the cardiovascular benefits of physical activity and structured exercise, ranging from improving the quality of life to reducing CVD and overall mortality. Therefore, exercise should be treated as a pow...

The six-minute walk test (6MWT) provides an objective measurement of a person’s functional exercise capacity. In this study, we developed a smartphone application that allows cardiac patients to do a self-administered 6MWT at home on a random trajectory. In a prospective study with 102 cardiovascular disease patients, we aimed to identify the optim...

Funding Acknowledgements Type of funding sources: Other. Main funding source(s): The AF-EduCare study is a project supported by the Fund for Scientific Research, Flanders (T002917N). The AF-EduApp study is supported by an BMS/Pfizer European Thrombosis Investigator Initiated Research Program (ERISTA) grant. Background Treatment with oral anticoagu...

Funding Acknowledgements Type of funding sources: None. Introduction Photoplethysmography (PPG)-based blood pressure (BP) measurements are available in the latest smartwatches and are thus available for patients in the consumer market. While the devices typically comply with the medical device regulation, accuracy is often not known and data on va...

Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Daiichi Sankyo Introduction Dietary habits are a key factor influencing cardiovascular risk and its progression. Dietary counselling as part of current cardiac rehabilitation programmes has certain limitations: it is often intermittent wi...

PURPOSE: To evaluate whether type 2 diabetes mellitus (T2DM) patients who suffer from unexplained exercise-induced dyspnea display cardiac dysfunction during exercise. BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) frequently suffer from unexplained dyspnea. It is not fully understood whether these patients have a worse exercise capacit...

Purpose Exercise training improves exercise capacity in type 2 diabetes mellitus (T2DM). It remains to be elucidated whether such improvements result from cardiac or peripheral muscular adaptations, and whether these are intensity dependent. Methods 27 patients with T2DM [without known cardiovascular disease (CVD)] were randomized to high-intensit...

Frailty is an age-related decline in physical, socio-psychological and cognitive function that results in extreme vulnerability to stressors. Therefore, this study aimed to elucidate which tests have to be selected to detect frailty in a comprehensive and feasible manner in cardiovascular disease (CVD) patients based on multivariate regression and...

Introduction Patients suffering from coronary heart disease (CHD) are frequently less active. Physical Activity (PA) could be increased through changes in routine travel behaviour. Achieving a certain PA amount is essential in the secondary prevention of CHD patients. Objective This study combines objective monitoring together with an intervention...

It all started with the European Society of Cardiology In 1946 and 1948, in connection with the Second and Third Inter-American Congresses of Cardiology held in Mexico and Chicago, several leading European cardiologists discussed the creation of a European Society of Cardiology (ESC). In 1949, a preliminary meeting was held in Brussels with represe...

Little data is available about the pathophysiological mechanisms of unexplained dyspnea and their clinical meaning. Consecutive patients with unexplained dyspnea underwent prospective standardized cardiopulmonary exercise testing with echocardiography (CPETecho). Patients were grouped as having normal exercise capacity (peak VO2 > 80% with respirat...

Aims: Diastolic stress testing (DST) is recommended to confirm heart failure with preserved ejection fraction (HFpEF) in patients with exertional dyspnea, but current algorithms do not detect all patients. We aimed to identify additional echocardiographic markers of elevated pulmonary arterial wedge pressure during exercise (exPAWP) in patients re...

Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes‐Genis (Spain)...

Digital health in cardiovascular prevention and rehabilitation In recent years, digital health has found its way into clinical practice. In cardiology, there is a shift from providing care in the hospital to providing care at the patient’s home, i.e. a shift from intramural to extramural care. This article offers an overview of the current use of d...

After a cardiac event, patients typically enroll in a cardiac rehabilitation program in a rehabilitation center, where physiotherapists guide them in overcoming their fear to move and increasing physical activity. Effectively changing patients’ health behaviour and bringing the newly formed habits to their home environment remains challenging. At h...

Introduction Digital technology creates the opportunity to develop and evaluate new tools, such as smartphone applications, to support integrated atrial fibrillation management. This study aimed to develop, evaluate, and validate a new, integrated care application (AF-EduApp) mainly focusing on targeted atrial fibrillation education to improve pati...

Aims Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and mana...

Aims Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and mana...

Background: Heart failure (HF) is a common cause of hospitalisation and mortality in elderly. The frequent rehospitalisations put a serious burden on patients, health-care budgets, and health-care capacity. Frequent hospital admissions are also associated with a substantial additional hazard for serious complications and reduced quality of life. T...

Background: Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients due to absence of good OSA screening pathways. Polysomnography (PSG) is the gold standard for diagnosing OSA but too resource-intensive as a screening tool. We explored whether cardiorespiratory polygraphy (PG) d...

Aims The prevalence of type 2 diabetes mellitus (T2DM) is very high and still rising. Optimal medical therapy and lifestyle management are essential in reducing the long-term complications of T2DM. Gamification, which is the use of design elements, and characteristics of games in a non-gaming context, is an innovative approach to improve healthy b...

Aims Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and mana...

Aims Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and mana...

Cardiac rehabilitation (CR) is a well-known intervention for the secondary prevention of cardiovascular diseases. However, in Japan, the outpatient CR participation rate is estimated to be very low. Cardiac telerehabilitation (CTR) can be defined as a remote CR program using digital health technology to support it. Evidence regarding the use of CTR...

Aims: To develop a set of quality indicators (QIs) for the evaluation of the care and outcomes for atherosclerotic cardiovascular disease (ASCVD) prevention. Methods and results: The Quality Indicator Committee of the European Society of Cardiology (ESC) formed the Working Group for Cardiovascular Disease Prevention Quality Indicators in collabo...

Introduction Cardiac rehabilitation (CR) is indicated in patients with cardiovascular disease but participation rates remain low. Telerehabilitation (TR) is often proposed as a solution. While many trials have investigated TR, few have studied participation rates in conventional CR non-participants. The aim of this study was to identify the percent...

Background Atrial fibrillation (AF) is the most common type of arrhythmia. The health burden of AF keeps increasing with the rising incidence of AF caused by the aging population and the high prevalence of unhealthy lifestyle. Pulmonary vein isolation (PVI) is the cornerstone of invasive rhythm control treatment in AF. Randomized controlled trials...

Background Obstructive sleep apnea (OSA) is a modifiable risk factor of atrial fibrillation (AF) but is underdiagnosed in these patients. According to the 2020 European Society of Cardiology guidelines for the diagnosis and management of AF, it seems reasonable to test for OSA in symptomatic AF patients before initiation of rhythm control therapy....

Background: Mechanical efficiency (ME) might be an important parameter evaluating cardiometabolic health and the effectiveness of physical activity interventions in individuals with obesity. However, whether these cardiometabolic risk factors may relate to ME in adolescents with obesity is not known yet. Therefore, this study aims to compare the m...

Aims Coronary artery disease (CAD) is related to high rates of morbidity and mortality among cardiovascular diseases (CVDs). Activity trackers have been used in cardiac rehabilitation (CR) in the last years. However, their effectiveness to influence outcomes after CAD is debated. This review summarizes the latest data of impact of activity trackers...

Background Obstructive sleep apnoea (OSA) is an important modifiable risk factor for atrial fibrillation (AF) but is underdiagnosed in this population. Currently, polysomnography is the gold standard for diagnosing OSA, but is expensive and requires overnight examination. Alternatively, home sleep apnoea testing can be used as a diagnostic tool, bu...