<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03260582</url>
  </required_header>
  <id_info>
    <nct_id>NCT03260582</nct_id>
  </id_info>
  <brief_title>Implementation and Assessment of a Life-style Focused Patient Support Application in Myocardial Infarction Patients</brief_title>
  <official_title>Implementation and Assessment of a Life-style Focused Patient Support Application (App) and Activity Trackers for Improving Risk Factor Management, Physical Activity, Quality of Life and Prognosis in Post-myocardial Infarction Patients</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Lund University</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Lund University</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      The study will assess the efficacy of a web-based application as a complement to traditional&#xD;
      exercise-based cardiac rehabilitation for improvement of secondary prevention outcomes in&#xD;
      post-myocardial infarction patients, compared with usual care. The hypothesis is that the&#xD;
      intervention enhances patient adherence to lifestyle advice (exercise training, daily&#xD;
      physical activity, healthy diet and tobacco abstinence) and medication, resulting in better&#xD;
      risk factor control and prognosis as well as increased self-rated health.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      It is well documented that participation in cardiac rehabilitation (CR) programs improves&#xD;
      risk factor control and therapy adherence, enhances quality of life and reduces recurrent&#xD;
      events. However, the current incomplete fulfilment of guideline recommended CR targets is a&#xD;
      matter of concern. Also, while international recommendations advocate program flexibility and&#xD;
      individual tailoring, most of the current CR programs are rigid, time-limited and demand&#xD;
      substantial health care resources. Therefore, all main international heart associations have&#xD;
      claimed for the reengineering of CR to enhance access, adherence, and effectiveness. The&#xD;
      general call is for the development of innovative and cost-effective CR programs oriented to&#xD;
      modify lifestyle and behaviour with sustainable results and that may be easily integrated in&#xD;
      the pre-existing health care structures.eHealth i.e. the use of electronic communication and&#xD;
      information technologies in health care, offers a whole new array of possibilities to provide&#xD;
      clinical care. These include for example distance monitoring via telecommunication and&#xD;
      sensors, interactive computer programs and smart phone applications. While there are&#xD;
      thousands of available eHealth applications on the market, only a small minority have been&#xD;
      tested in a controlled manner with proper guidance from health care personnel. The study will&#xD;
      assess the efficacy of a web-based patient support application as a complement to traditional&#xD;
      exercise-based CR for improvement of secondary prevention outcomes in post-MI patients,&#xD;
      compared with usual care. The hypothesis is that the intervention enhances patient adherence&#xD;
      to lifestyle advice (exercise training, daily physical activity, healthy diet and tobacco&#xD;
      abstinence) and medication, resulting in better risk factor control and prognosis as well as&#xD;
      increased self-rated health. A secondary hypothesis is that complementing the application&#xD;
      with an activity tracker (accelerometer in a smart bracelet) will enhance the effect of the&#xD;
      intervention.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">April 2016</start_date>
  <completion_date type="Actual">June 2019</completion_date>
  <primary_completion_date type="Actual">June 2019</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Change in submaximal exercise capacity in watts (W)</measure>
    <time_frame>Change between first (2-4 weeks post-MI) and second (4-6 months post-MI) submaximal exercise test conducted at physiotherapist visits</time_frame>
    <description>Submaximal exercise capacity reflects the patients´ level of physical fitness.The submaximal exercise test is performed on a bicycle ergometer according to the World Health Organisation (WHO) protocol, with an increased workload of 25W every 4.5 minutes The initial starting load, 25W or 50W, is decided, based on the patient's exertion history. After two and four minutes of each workload; heart rate, rate of perceived exertion according to Borg's rating of perceived exertion scale (RPE) and subjective symptoms, including chest pain and dyspnea according to Borg's Category Ratio Scale, CR-10, scale are rated. After three minutes, the systolic blood pressure is registered. The exercise test is discontinued at Borg RPE 17 and/or dyspnea 7 on Borg's CR-10 scale.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Change in self-reported health</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Self-reported Health is measured using the Visual Analogue Scale (0-100)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in healthy diet index</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>The healthy diet index is a four-item questionnaire used to evaluate dietary habits within the Swedish Secondary Prevention after Heart Intensive Care Admission (SEPHIA) registry</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Smoking habits</measure>
    <time_frame>First (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Whether the patient is a non-smoker, prior smoker or current smoker (self-report)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in weight</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Weight measured in kg</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in BMI</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Weight in kilograms (kg) divided by height in meters (m) square</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in waist circumference</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Waist circumference measured in cm</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in systolic blood pressure</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Systolic blood pressure measured after 5 minutes of rest in supine position (mmHg)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in diastolic blood pressure</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Diastolic blood pressure measured after 5 minutes of rest in supine position (mmHg)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in total cholesterol</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Fasting plasma total cholesterol</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in LDL cholesterol</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Fasting plasma LDL cholesterol (mmol/L)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in HDL cholesterol</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Fasting plasma HDL cholesterol (mmol/L)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in triglycerides</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Fasting plasma triglycerides (mmol/L)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in fasting plasma glucose</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Fasting plasma glucose (mg/dL)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Change in hemoglobin A1c</measure>
    <time_frame>Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI</time_frame>
    <description>Whole-blood hemoglobin A1c (mmol/mol) by International Federation of Clinical Chemistry (IFCC) standards</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Changes in self-reported physical activity</measure>
    <time_frame>Change between baseline, first (2-4 weeks post-MI) and second (4-6 months post-MI) physiotherapist visits post-MI</time_frame>
    <description>Self-reported physical activity, as measured by Haskell and Frändin &amp; Grimby</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Uptake</measure>
    <time_frame>Six months</time_frame>
    <description>The proportion of patients who log on to the patient interface at least once</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Adherence</measure>
    <time_frame>Six months</time_frame>
    <description>The proportion of patients registering data at least twice per week on a weekly basis throughout the intervention period</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Number of contacts with the CR staff</measure>
    <time_frame>12-14 months</time_frame>
    <description>Number of telephone and physical contacts with the CR staff during the follow-up period</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Incident cardiovascular events at one year</measure>
    <time_frame>One year</time_frame>
    <description>Incidence of cardiovascular events at one year after the index event: hospitalization for a new MI, heart failure or stroke and cardiovascular death</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Incident cardiovascular events at three years</measure>
    <time_frame>Three years</time_frame>
    <description>Incidence of cardiovascular events at three years after the index event: hospitalization for a new MI, heart failure or stroke and cardiovascular death</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">150</enrollment>
  <condition>Myocardial Infarction</condition>
  <arm_group>
    <arm_group_label>Control arm (n=50)</arm_group_label>
    <arm_group_type>No Intervention</arm_group_type>
    <description>Patients randomized to the control arm will receive usual cardiac rehabilitation care post-myocardial infarction.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Intervention arm: LifePod arm (n=100)</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>In addition to usual cardiac rehabilitation care, patients randomized to the LifePod arm will receive access to the LifePod® support software for six months.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>LifePod®</intervention_name>
    <description>The software is a web-based application designed to support persons adhering to lifestyle advice and medication. The patient can log information about lifestyle (i.e. diet, exercise, and smoking), measurements (i.e. weight, pulse and blood pressure), symptoms and medication and can review data in graphs displaying registered values in relation to recommended targets. The software provides positive feedback on healthy choices and gives general recommendations on exercise training, physical activity and healthy diet. Reminders are generated in the case of decreasing registrations. Finally, short text messages (SMS) will be sent out 2-3 times a week with tips on healthy lifestyle.</description>
    <arm_group_label>Intervention arm: LifePod arm (n=100)</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion criteria&#xD;
&#xD;
          -  Age &lt; 75 years. This cut-off is set as only those &lt; 75 years of age are followed in&#xD;
             the national Secondary Prevention after Heart Intensive Care Admission (SEPHIA)&#xD;
             registry&#xD;
&#xD;
          -  Has suffered an MI within the last 2 weeks&#xD;
&#xD;
          -  Owns a smartphone and/or has access to internet via a computer or surf pad and can&#xD;
             handle the software&#xD;
&#xD;
        Exclusion criteria&#xD;
&#xD;
          -  Expected survival &lt; 1 year&#xD;
&#xD;
          -  Dementia, severe psychiatric illness or drug abuse&#xD;
&#xD;
          -  Severe physical handicap limiting the patient´s ability to participate in&#xD;
             exercise-based CR&#xD;
&#xD;
          -  Not able to speak or understand the Swedish language&#xD;
&#xD;
          -  Three-vessel disease requiring coronary artery bypass grafting&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>74 Years</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Margret Leosdottir, MD, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>Skane University Hospital and Lund University, Malmo, Sweden</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Dept of Cardiology, Skane University Hospital</name>
      <address>
        <city>Lund</city>
        <zip>222 41</zip>
        <country>Sweden</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Dept of Cardiology, Skane University Hospital</name>
      <address>
        <city>Malmo</city>
        <zip>20502</zip>
        <country>Sweden</country>
      </address>
    </facility>
  </location>
  <location>
    <facility>
      <name>Dept of Cardiology</name>
      <address>
        <city>Umeå</city>
        <zip>907 46</zip>
        <country>Sweden</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Sweden</country>
  </location_countries>
  <link>
    <url>http://www.cross-solutions.com/</url>
    <description>Cross Technology Solutions home page</description>
  </link>
  <verification_date>October 2019</verification_date>
  <study_first_submitted>June 14, 2017</study_first_submitted>
  <study_first_submitted_qc>August 23, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">August 24, 2017</study_first_posted>
  <last_update_submitted>October 24, 2019</last_update_submitted>
  <last_update_submitted_qc>October 24, 2019</last_update_submitted_qc>
  <last_update_posted type="Actual">October 25, 2019</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>cardiac rehabilitation</keyword>
  <keyword>eHealth</keyword>
  <keyword>smartphone application</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Myocardial Infarction</mesh_term>
    <mesh_term>Infarction</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>Undecided</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03260582
nct id: NCT03260582
lead sponsor: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
The study will assess the efficacy of a web-based application as a complement to traditional
      exercise-based cardiac rehabilitation for improvement of secondary prevention outcomes in
      post-myocardial infarction patients, compared with usual care. The hypothesis is that the
      intervention enhances patient adherence to lifestyle advice (exercise training, daily
      physical activity, healthy diet and tobacco abstinence) and medication, resulting in better
      risk factor control and prognosis as well as increased self-rated health.
It is well documented that participation in cardiac rehabilitation (CR) programs improves
      risk factor control and therapy adherence, enhances quality of life and reduces recurrent
      events. However, the current incomplete fulfilment of guideline recommended CR targets is a
      matter of concern. Also, while international recommendations advocate program flexibility and
      individual tailoring, most of the current CR programs are rigid, time-limited and demand
      substantial health care resources. Therefore, all main international heart associations have
      claimed for the reengineering of CR to enhance access, adherence, and effectiveness. The
      general call is for the development of innovative and cost-effective CR programs oriented to
      modify lifestyle and behaviour with sustainable results and that may be easily integrated in
      the pre-existing health care structures.eHealth i.e. the use of electronic communication and
      information technologies in health care, offers a whole new array of possibilities to provide
      clinical care. These include for example distance monitoring via telecommunication and
      sensors, interactive computer programs and smart phone applications. While there are
      thousands of available eHealth applications on the market, only a small minority have been
      tested in a controlled manner with proper guidance from health care personnel. The study will
      assess the efficacy of a web-based patient support application as a complement to traditional
      exercise-based CR for improvement of secondary prevention outcomes in post-MI patients,
      compared with usual care. The hypothesis is that the intervention enhances patient adherence
      to lifestyle advice (exercise training, daily physical activity, healthy diet and tobacco
      abstinence) and medication, resulting in better risk factor control and prognosis as well as
      increased self-rated health. A secondary hypothesis is that complementing the application
      with an activity tracker (accelerometer in a smart bracelet) will enhance the effect of the
      intervention.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: None (Open Label)
measure: Change in submaximal exercise capacity in watts (W)
time frame: Change between first (2-4 weeks post-MI) and second (4-6 months post-MI) submaximal exercise test conducted at physiotherapist visits
description: Submaximal exercise capacity reflects the patients´ level of physical fitness.The submaximal exercise test is performed on a bicycle ergometer according to the World Health Organisation (WHO) protocol, with an increased workload of 25W every 4.5 minutes The initial starting load, 25W or 50W, is decided, based on the patient's exertion history. After two and four minutes of each workload; heart rate, rate of perceived exertion according to Borg's rating of perceived exertion scale (RPE) and subjective symptoms, including chest pain and dyspnea according to Borg's Category Ratio Scale, CR-10, scale are rated. After three minutes, the systolic blood pressure is registered. The exercise test is discontinued at Borg RPE 17 and/or dyspnea 7 on Borg's CR-10 scale.
measure: Change in self-reported health
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Self-reported Health is measured using the Visual Analogue Scale (0-100)
measure: Change in healthy diet index
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: The healthy diet index is a four-item questionnaire used to evaluate dietary habits within the Swedish Secondary Prevention after Heart Intensive Care Admission (SEPHIA) registry
measure: Smoking habits
time frame: First (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Whether the patient is a non-smoker, prior smoker or current smoker (self-report)
measure: Change in weight
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Weight measured in kg
measure: Change in BMI
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Weight in kilograms (kg) divided by height in meters (m) square
measure: Change in waist circumference
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Waist circumference measured in cm
measure: Change in systolic blood pressure
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Systolic blood pressure measured after 5 minutes of rest in supine position (mmHg)
measure: Change in diastolic blood pressure
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Diastolic blood pressure measured after 5 minutes of rest in supine position (mmHg)
measure: Change in total cholesterol
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Fasting plasma total cholesterol
measure: Change in LDL cholesterol
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Fasting plasma LDL cholesterol (mmol/L)
measure: Change in HDL cholesterol
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Fasting plasma HDL cholesterol (mmol/L)
measure: Change in triglycerides
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Fasting plasma triglycerides (mmol/L)
measure: Change in fasting plasma glucose
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Fasting plasma glucose (mg/dL)
measure: Change in hemoglobin A1c
time frame: Change between baseline, first (6-8 weeks post-MI) and second (12-14 months post-MI) nurse visits post-MI
description: Whole-blood hemoglobin A1c (mmol/mol) by International Federation of Clinical Chemistry (IFCC) standards
measure: Changes in self-reported physical activity
time frame: Change between baseline, first (2-4 weeks post-MI) and second (4-6 months post-MI) physiotherapist visits post-MI
description: Self-reported physical activity, as measured by Haskell and Frändin & Grimby
measure: Uptake
time frame: Six months
description: The proportion of patients who log on to the patient interface at least once
measure: Adherence
time frame: Six months
description: The proportion of patients registering data at least twice per week on a weekly basis throughout the intervention period
measure: Number of contacts with the CR staff
time frame: 12-14 months
description: Number of telephone and physical contacts with the CR staff during the follow-up period
measure: Incident cardiovascular events at one year
time frame: One year
description: Incidence of cardiovascular events at one year after the index event: hospitalization for a new MI, heart failure or stroke and cardiovascular death
measure: Incident cardiovascular events at three years
time frame: Three years
description: Incidence of cardiovascular events at three years after the index event: hospitalization for a new MI, heart failure or stroke and cardiovascular death
arm group label: Control arm (n=50)
arm group type: No Intervention
description: Patients randomized to the control arm will receive usual cardiac rehabilitation care post-myocardial infarction.
arm group label: Intervention arm: LifePod arm (n=100)
arm group type: Experimental
description: In addition to usual cardiac rehabilitation care, patients randomized to the LifePod arm will receive access to the LifePod® support software for six months.
intervention type: Other
intervention name: LifePod®
description: The software is a web-based application designed to support persons adhering to lifestyle advice and medication. The patient can log information about lifestyle (i.e. diet, exercise, and smoking), measurements (i.e. weight, pulse and blood pressure), symptoms and medication and can review data in graphs displaying registered values in relation to recommended targets. The software provides positive feedback on healthy choices and gives general recommendations on exercise training, physical activity and healthy diet. Reminders are generated in the case of decreasing registrations. Finally, short text messages (SMS) will be sent out 2-3 times a week with tips on healthy lifestyle.
arm group label: Intervention arm: LifePod arm (n=100)
criteria: 
gender: All
minimum age: 18 Years
maximum age: 74 Years
healthy volunteers: No
last name: Margret Leosdottir, MD, PhD
role: Principal Investigator
affiliation: Skane University Hospital and Lund University, Malmo, Sweden
facility: 
facility: 
facility: 
country: Sweden
url: http://www.cross-solutions.com/
description: Cross Technology Solutions home page
responsible party type: Sponsor
mesh term: Myocardial Infarction
mesh term: Infarction
sharing ipd: Undecided