Mobile Health Technology for Atrial Fibrillation Management Integrating Decision Support, Education, and Patient Involvement: mAF App Trial

Yutao Guo; Yundai Chen; Deirdre A Lane; Lihong Liu; Yutang Wang; Gregory Y H Lip

doi:10.1016/j.amjmed.2017.07.003

Mobile Health Technology for Atrial Fibrillation Management Integrating Decision Support, Education, and Patient Involvement: mAF App Trial

Am J Med. 2017 Dec;130(12):1388-1396.e6. doi: 10.1016/j.amjmed.2017.07.003. Epub 2017 Aug 26.

Authors

Yutao Guo¹, Yundai Chen², Deirdre A Lane³, Lihong Liu⁴, Yutang Wang¹, Gregory Y H Lip⁵

Affiliations

¹ Chinese PLA General Hospital, Beijing, China.
² Chinese PLA General Hospital, Beijing, China. Electronic address: Yundai_Chen301@163.com.
³ Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
⁴ Meishan City People's Hospital, Chendgdu, China.
⁵ Chinese PLA General Hospital, Beijing, China. Electronic address: g.y.h.lip@bham.ac.uk.

PMID: 28847546
DOI: 10.1016/j.amjmed.2017.07.003

Abstract

Background: Mobile Health technology for the management of patients with atrial fibrillation is unknown.

Methods: The simple mobile AF (mAF) App was designed to incorporate clinical decision-support tools (CHA₂DS₂-VASc [Congestive heart failure, Hypertension, Age ≥75 years, Diabetes Mellitus, Prior Stroke or TIA, Vascular disease, Age 65-74 years, Sex category], HAS-BLED [Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile INR, Elderly, Drugs/alcohol concomitantly], SAMe-TT₂R₂ [Sex, Age <60 years, Medical history, Treatment, Tobacco use, Race] scores), educational materials, and patient involvement strategies with self-care protocols and structured follow-up. Patients with atrial fibrillation were randomized into 2 groups (mAF App vs usual care) in a cluster randomized design pilot study. Patients' knowledge, quality of life, drug adherence, and anticoagulation satisfaction were evaluated at baseline, 1 month, and 3 months. Usability, feasibility, and acceptability of the mAF App were assessed at 1 month.

Results: A total of 113 patients were randomized to mAF App intervention (mean age, 67.4 years; 57.5% were male; mean follow-up, 69 days), and 96 patients were randomized to usual care (mean age, 70.9 years; 55.2% were male; mean follow-up, 95 days). More than 90% of patients reported that the mAF App was easy, user-friendly, helpful, and associated with significant improvements in knowledge compared with the usual care arm (P values for trend <.05). Drug adherence and anticoagulant satisfaction were significantly better with the mAF App versus usual care (all P < .05). Quality of life scores were significantly increased in the mAF App arm versus usual care, with anxiety and depression reduced (all P < .05).

Conclusions: The pilot mAFA Trial is the first prospective randomized trial of Mobile Health technology in patients with atrial fibrillation, demonstrating that the mAF App, integrating clinical decision support, education, and patient-involvement strategies, significantly improved knowledge, drug adherence, quality of life, and anticoagulation satisfaction.

Keywords: Atrial fibrillation; Drug adherence; Mobile health; Patient education.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Atrial Fibrillation / therapy*
Decision Support Systems, Clinical*
Female
Humans
Male
Mobile Applications*
Patient Education as Topic*
Patient Participation*
Pilot Projects
Prospective Studies
Telemedicine / methods*