A systematic review of mobile health opportunities for atrial fibrillation detection and management

Hermans, Astrid N L; Gawałko, Monika; Dohmen, Lisa; Velden, Rachel M J van der; Betz, Konstanze; Verhaert, Dominique V M; Pluymaekers, Nikki A H A; Hendriks, Jeroen; Linz, Dominik

doi:10.1093/eurjpc/zwab158

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…The number of mobile health (mHealth) applications dedicated to heart rate and rhythm monitoring in patients with atrial fibrillation (AF) is constantly increasing with growing numbers of devices and/ or applications with Conformité Européenne (CE) and/or Food and Drug Administration approval. 1,2 Despite high accuracy to detect AF, the efficacy of these mHealth applications is critically determined by the ability and willingness of the patient to use them. The World Health Organization (WHO) has stated that increasing patient adherence to interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments.…”

Section: Introductionmentioning

confidence: 99%

Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring for atrial fibrillation management: data from the TeleCheck-AF project

Gawałko

Hermans

Velden

et al. 2022

European Journal of Cardiovascular Nursing

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Aims The aim of this TeleCheck-AF sub-analysis was to evaluate motivation and adherence to on-demand heart rate/rhythm monitoring app in patients with atrial fibrillation (AF). Methods and results Patients were instructed to perform 60 s app-based heart rate/rhythm recordings 3 times daily and in case of symptoms for 7 consecutive days prior to teleconsultation. Motivation was defined as number of days in which the expected number of measurements (≥3/day) were performed per number of days over the entire prescription period. Adherence was defined as number of performed measurements per number of expected measurements over the entire prescription period. Data from 990 consecutive patients with diagnosed AF [median age 64 (57–71) years, 39% female] from 10 centres were analyzed. Patients with both optimal motivation (100%) and adherence (≥100%) constituted 28% of the study population and had a lower percentage of recordings in sinus rhythm [90 (53–100%) vs. 100 (64–100%), P < 0.001] compared with others. Older age and absence of diabetes were predictors of both optimal motivation and adherence [odds ratio (OR) 1.02, 95% coincidence interval (95% CI): 1.01–1.04, P < 0.001 and OR: 0.49, 95% CI: 0.28–0.86, P = 0.013, respectively]. Patients with 100% motivation also had ≥100% adherence. Independent predictors for optimal adherence alone were older age (OR: 1.02, 95% CI: 1.00–1.04, P = 0.014), female sex (OR: 1.70, 95% CI: 1.29–2.23, P < 0.001), previous AF ablation (OR: 1.35, 95% CI: 1.03–1.07, P = 0.028). Conclusion In the TeleCheck-AF project, more than one-fourth of patients had optimal motivation and adherence to app-based heart rate/rhythm monitoring. Older age and absence of diabetes were predictors of optimal motivation/adherence.

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Section: Introductionmentioning

confidence: 99%

Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring for atrial fibrillation management: data from the TeleCheck-AF project

Gawałko

Hermans

Velden

et al. 2022

European Journal of Cardiovascular Nursing

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“…23 With the expected surge in AF prevalence, 3 24 25 this underlines that a suited screening strategy is needed to identify and treat AF to mitigate mortality, morbidity, and health care expenses. 26 27 But before this, evidence is needed with regard to OAC treatment in subclinical AF. 15 Indeed, screening AF is gaining momentum but remains unknown territory with respect to side effects—that is, early detection and treatment may come with a different risk-benefit trade-off compared with what is known from conventionally diagnosed AF.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation-Associated Bleeding in Patients Screened for Atrial Fibrillation versus Usual Care—A Post Hoc Analysis from the LOOP Study

Kongebro,

Diederichsen,

Xing

et al. 2023

TH Open

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Background Atrial fibrillation (AF) prevalence is rising, however data on the bleeding risks associated with detection of subclinical AF are needed. Objective To determine the bleeding increment associated with implantable loop recorder (ILR) screening for subclinical AF and subsequent anticoagulation initiation compared to usual care. Methods This post-hoc study utilized LOOP trial data from 6004 elderly patients with stroke risks randomised to either ILR (n=1503) or usual care (n=4503). The mean follow-up time was 64.5 months, and none were lost to follow-up. The primary exposure was the initiation of oral anticoagulation, and the main outcome was the risk of major bleeding events following initiation of oral anticoagulants (OAC), determined by time-dependent cox regression. Secondly, we investigated antithrombotic prescription patterns and major bleeding events after antiplatelets treatment and in subgroups. Results OAC was initiated in 1019 participants with a mean age (yrs) at 78.8 (±4.67) in Control vs. 77.0 (±4.84) in ILR, p<0.0001. All cases of OAC discontinuation reached 202, and in AF-patients (n=910) alone paused 105 (72%) paticipants temporarily OAC and 40 (28%) ended OAC treatment completelety during follow-up. Major bleeding events totalled 221 (3.7%). Forty-seven major bleeding events followed an OAC initiation in 1019 participants (4.6%); 26 vs. 21 events in the control and ILR group respectively. The hazard ratio (HR) for major bleeding after OAC initiation compared to before was 2.08 (1.50-2.90) p<0.0001 overall; 2.81 (1.82-4.34) p<0.0001 for Control and 1.32 (0.78-2.23) p=0.31 for the ILR group (p=0.07 for interaction). Antiplatelet treatment resulted in an overall adjusted HR of 1.3 (0.96-1.75) p=0.09. For OAC-users aged ≥75 years in the ILR group, the rate of major bleeding was 1.73 (0.92-2.96) compared to 0.84 (0.36-1.66) for an age <75 years, and the rate of the corresponding Control subgroup aged ≥75 years was 2.20 (1.23-3.63) compared to 1.64 (0.82-2.93) for an age <75 years. Conclusion The individual risk of major bleeding increased two-fold after initiation of oral anticoagulation for all patients in this study. However, the patients screened for subclinical AF did not have a higher bleeding risk after initiation of anticoagulation compared to those in usual care.

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Changes in healthcare utilisation during implementation of remote atrial fibrillation management: TeleCheck-AF project

Gawałko,

Betz,

Hendriks

et al. 2024

Neth Heart J

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Aim To evaluate changes in healthcare utilisation and comprehensive packages of care activities and procedures (referred in the Netherlands to as ‘diagnose-behandelcombinatie (DBC) care products) during the implementation of the TeleCheck-AF approach (teleconsultation supported by app-based heart rate/rhythm monitoring) in a Dutch atrial fibrillation (AF) clinic. Methods and results In the Maastricht University Medical Centre+ AF Clinic, data on healthcare utilisation and DBC care products for patients consulted by both a conventional approach in 2019 and the TeleCheck-AF approach in 2020 were analysed. A patient experience survey was performed. Thirty-seven patients (median age 68 years; 40% women) were analysed. With the conventional approach, 35 face-to-face consultations and 0 teleconsultations were conducted. After the implementation of TeleCheck-AF, the number of face-to-face consultations dropped by 80% (p < 0.001) and teleconsultations increased to 45 (p < 0.001). While 42 electrocardiograms (ECGs) and 25 Holter ECGs or echocardiograms were recorded when using the conventional approach, the number of ECGs decreased by 71% (p < 0.001) and Holter ECGs or echocardiograms by 72% (p < 0.001) with the TeleCheck-AF approach. The emergency department patient presentations showed no statistically significant change (p = 0.33). Overall, 57% of medium-weight DBC care products were changed to light-weight ones during implementation of the TeleCheck-AF approach. Patient satisfaction with the TeleCheck-AF approach was high. Conclusion The implementation of TeleCheck-AF led to a change in healthcare utilisation, a change from medium-weight to light-weight DBC care products and a reduction in patient burden. These results created the basis for a new reimbursement code for the TeleCheck-AF approach in the Netherlands.

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A systematic review of mobile health opportunities for atrial fibrillation detection and management

Cited by 4 publications

References 14 publications

Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring for atrial fibrillation management: data from the TeleCheck-AF project

Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring for atrial fibrillation management: data from the TeleCheck-AF project

Anticoagulation-Associated Bleeding in Patients Screened for Atrial Fibrillation versus Usual Care—A Post Hoc Analysis from the LOOP Study

Changes in healthcare utilisation during implementation of remote atrial fibrillation management: TeleCheck-AF project

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