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Original research
Mobile health adherence for the detection of recurrent recent-onset atrial fibrillation
  1. Rachel M J van der Velden1,
  2. Nikki A H A Pluymaekers1,
  3. Elton A M P Dudink1,
  4. Justin G L M Luermans1,2,
  5. Joan G Meeder3,
  6. Wilfred F Heesen3,
  7. Timo Lenderink4,
  8. Jos W M G Widdershoven5,
  9. Jeroen J J Bucx6,
  10. Michiel Rienstra7,
  11. Otto Kamp8,
  12. Jurren M van Opstal9,
  13. Charles J H J Kirchhof10,
  14. Vincent F van Dijk11,
  15. Henk P Swart12,
  16. Marco Alings13,
  17. Isabelle C Van Gelder7,
  18. Harry J G M Crijns1,
  19. Dominik Linz1,14,15
  1. 1Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
  2. 2Cardiology, RadboudUMC, Nijmegen, The Netherlands
  3. 3Cardiology, VieCuri Medisch Centrum, Venlo, The Netherlands
  4. 4Cardiology, Zuyderland Medisch Centrum Heerlen, Heerlen, The Netherlands
  5. 5Cardiology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
  6. 6Cardiology, Diakonessenhuis Utrecht Zeist Doorn, Utrecht, The Netherlands
  7. 7Cardiology, UMCG, Groningen, The Netherlands
  8. 8Cardiology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
  9. 9Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
  10. 10Cardiology, Alrijne Hospital, Leiden, The Netherlands
  11. 11Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
  12. 12Cardiology, Antonius Hospital, Sneek, The Netherlands
  13. 13Cardiology, Amphia Hospital, Breda, The Netherlands
  14. 14Biomedical Sciences, University of Copenhagen, Kobenhavn, Denmark
  15. 15Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
  1. Correspondence to Rachel M J van der Velden, Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands; rachel.vander.velden{at}mumc.nl

Abstract

Objective The Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See trial compared early to delayed cardioversion for patients with recent-onset symptomatic atrial fibrillation (AF). This study aims to evaluate the adherence to a 4-week mobile health (mHealth) prescription to detect AF recurrences after an emergency department visit.

Methods After the emergency department visit, the 437 included patients, irrespective of randomisation arm (early or delayed cardioversion), were asked to record heart rate and rhythm for 1 min three times daily and in case of symptoms by an electrocardiography-based handheld device for 4 weeks (if available). Adherence was appraised as number of performed measurements per number of recordings asked from the patient and was evaluated for longitudinal adherence consistency. All patients who used the handheld device were included in this subanalysis.

Results 335 patients (58% males; median age 67 (IQR 11) years) were included. The median overall adherence of all patients was 83.3% (IQR 29.9%). The median number of monitoring days was 27 out of 27 (IQR 5), whereas the median number of full monitoring days was 16 out of 27 (IQR 14). Higher age and a previous paroxysm of AF were identified as multivariable adjusted factors associated with adherence.

Conclusions In this randomised trial, a 4-week mHealth prescription to monitor for AF recurrences after an emergency department visit for recent-onset AF was feasible with 85.7% of patients consistently using the device with at least one measurement per day. Older patients were more adherent.

Trial registration number NCT02248753.

  • atrial fibrillation

Data availability statement

Data are available on reasonable request. Data will be made available after an application atcarim-office@maastrichtuniversity.nl.

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Data availability statement

Data are available on reasonable request. Data will be made available after an application atcarim-office@maastrichtuniversity.nl.

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Footnotes

  • Twitter @N_Pluymaekers

  • Contributors NP, ED, JL, JGM, TL, JW, JJJB, MR, OK, JMvO, CJHJK, VFvD, MA, IVG and HJGMC were involved in the design and/or conduct of the main study. NP, HJGMC, DL and RMJvdV were involved in drafting the research question for this subanalysis. NP and RMJvdV collected and reviewed the data from the handheld devices. DL reviewed the data from the handheld devices in case of discrepancies. RMJvdV analysed the data and wrote the manuscript with support from NP, ED, HJGMC and DL. RMJvdV acts as guarantor for this study. All authors provided critical feedback with regard to the research, analysis and manuscript.

  • Funding The present substudy was not funded. The RACE 7 ACWAS trial was supported by a grant (837002524) from the Netherlands Organization for Health Research and Development–Health Care Efficiency Research Programme and by the Maastricht University Medical Center. Boehringer Ingelheim provided some of the remote monitoring devices.

  • Competing interests JL has a consultancy agreement with Medtronic and has received speakers fee from Bayer and Novartis, and a research grant ZonMW LEAP trial project number 852002101. MR has received consultancy fees from Medtronic, Arca Biopharma and Roche to the institution, unrestricted research grant from ZonMW and the Dutch Heart Foundation; DECISION project 848090001. Unrestricted research grants from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation; RACE V (CVON2014-9), RED-CVD (CVON2017-11). Unrestricted research grant from Top Sector Life Sciences & Health to the Dutch Heart Foundation (PPP Allowance; CVON-AI (2018B017)). Unrestricted research grant from the European Union’s Horizon 2020 research and innovation programme under grant agreement; EHRA-PATHS (945260). IVG has received consultancy fees Institute from Medtronic, Daiichi, BMS, Bayer and Roche to the institution, unrestricted research grants from the Netherlands Cardiovascular Research Initiative: an initiative with support of the Dutch Heart Foundation; unrestricted research grant from the European Union’s Horizon 2020 research and innovation programme under grant agreement; EHRA-PATHS (945260).

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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