No abstract

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Netherlands Organization for Health Research and Development–Health Care Efficiency Research Program Introduction In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See (RACE 7 ACWAS) trial an early cardioversion approach was compared to a delayed cardioversion approach for patients with recent-onset symptomatic atrial fibrillation (AF), followed by a four-week monitoring period using mobile health (mHealth). Purpose To evaluate the adherence and motivation to a four-week mHealth prescription to daily intermittent rhythm monitoring for recurrences after emergency department visit in patients with recent-onset AF. In addition, we studied predictors of mHealth adherence and motivation and evaluated whether recurrences during this four-week period influenced adherence and motivation patterns. Methods After the index visit, patients were asked to use an electrocardiographic-based telemetric device to record one minute heart rate and rhythm recordings three times daily and in case of symptoms during a period of four weeks. For patients who collected recordings for more than four weeks, data was censored at four weeks. Adherence and patient motivation based on the number of monitoring days and full monitoring days were evaluated. A p-value of <0.05 was considered statistically significant. Results 335 patients (58% men; median age 67±11 years) used the telemetric device and were included in the current analysis. The median overall adherence of all patients was 83.3% (IQR 29.9%). The median number of monitoring days was 27 (5), whereas the median number of full monitoring days was 16 (14). Age and the index episode being a recurrent paroxysm of AF rather than a first presentation were identified as independent predictors of adherence (odds ratio (OR) 1.037 (95%CI 1.015-1.060), p=0.001 and OR 1.863 (95%CI 1.190-2.916), p=0.007, respectively). Age (OR 1.031 (95%CI 1.009-1.053), p=0.005) and the use of antiarrhythmic drugs (OR 1.800 (95%CI 1.047-3.093), p=0.033) were identified as independent predictors of motivation. Patients with recurrences had significantly higher median adherence (87.7% vs 81.5%, p=0.028) and more full monitoring days (18 (14) days vs 15 (13) days, p=0.024), and were more likely to perform additional recordings (78.8% vs 49.2%, p=<0.001) compared to patients without recurrences. Conclusion Patients with recent-onset AF showed good adherence and motivation to a four-week mHealth prescription to monitor for AF recurrences after an emergency department visit for recent-onset AF. Adherence and motivation were high during the entire monitoring period, indicating that intermittent rhythm monitoring using mHealth is feasible for 1 month. Whether comparable mHealth adherence and motivation can be achieved in real world clinical scenarios outside a randomized study, warrants further observational studies.

No abstract

Funding Acknowledgements Type of funding sources: None. Introduction In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See (RACE 7 ACWAS) trial, a delayed cardioversion approach was compared to early cardioversion. Based on the results of this trial, the delayed cardioversion approach has been added to the European Society of Cardiology guidelines for atrial fibrillation (AF) as a strategy for the acute management of patients with recent-onset AF episodes. Purpose The aim of this study was to evaluate the impact of participation in the RACE 7 ACWAS trial, in combination with education on the delayed cardioversion approach, on the behaviour of patients regarding their recent-onset AF episodes. Methods Patients who were enrolled in the RACE 7 ACWAS trial in our centre and who gave their consent to be approached for future research projects were asked to complete a questionnaire, asking about AF recurrences and related treatment after their participation in the RACE 7 ACWAS trial. Results Of the 148 patients enrolled in the RACE 7 ACWAS trial in our centre, 130 patients were eligible for this study. Of these patients, 16 refused participation, 25 could not be reached and 16 did not return the questionnaire. Seventy-three patients (mean age 69, 64.4% men, 50.7% delayed cardioversion group) completed the questionnaire and were included in the current analysis. Forty-nine patients (67.1%) experienced AF recurrences after the trial. Of the patients with AF recurrences, 23 patients (46%) indicated that since their participation in the trial they have been waiting longer for spontaneous conversion to occur, i.e. 13 patients (26%) wait longer before contacting the emergency department (ED) and 10 patients (20%) wait as long as it takes for spontaneous conversion to occur. Twenty-five patients (51.0%) had been to the ED because of AF at least one time after their participation in the RACE 7 ACWAS trial. Eleven patients (45.8%) who contacted the ED were advised to wait at home a while longer before visiting the ED. In 13 patients (52%) a delayed cardioversion approach at the ED was applied at least once. Eleven patients experiencing recurrences (22.9%) indicated that ED visits had been avoided because the ED advised them telephonically to await spontaneous conversion longer (Figure 1). There were no significant differences between patients who were in the early cardioversion group compared to patients who were in the delayed cardioversion group (Table 1). Conclusion The RACE 7 ACWAS trial appears to have impacted the behaviour of approximately half of the included patients, who indicated that following participation in the trial they were more likely to await spontaneous conversion. Health care professionals at the ED adopted a delayed cardioversion strategy in half of all cases. In about 1 in every 4-5 patients, an ED visit was avoided because patients were telephonically advised to wait longer.

No abstract