Self-Reported Mobile Health-Based Risk Factor and CHA2DS2-VASc-Score Assessment in Patients With Atrial Fibrillation: TeleCheck-AF Results

Astrid N L Hermans; Monika Gawałko; Henrike A K Hillmann; Afzal Sohaib; Rachel M J van der Velden; Konstanze Betz; Dominique Verhaert; Daniel Scherr; Julia Meier; Arian Sultan; Daniel Steven; Elena Terentieva; Ron Pisters; Martin Hemels; Leonard Voorhout; Piotr Lodziński; Bartosz Krzowski; Dhiraj Gupta; Nikola Kozhuharov; Henri Gruwez; Kevin Vernooy; Nikki A H A Pluymaekers; Jeroen M Hendriks; Martin Manninger; David Duncker; Dominik Linz

doi:10.3389/fcvm.2021.757587

Self-Reported Mobile Health-Based Risk Factor and CHA₂DS₂-VASc-Score Assessment in Patients With Atrial Fibrillation: TeleCheck-AF Results

Front Cardiovasc Med. 2022 Jan 19:8:757587. doi: 10.3389/fcvm.2021.757587. eCollection 2021.

Authors

Astrid N L Hermans¹, Monika Gawałko^{1

2

3}, Henrike A K Hillmann⁴, Afzal Sohaib^{5

6}, Rachel M J van der Velden¹, Konstanze Betz¹, Dominique Verhaert^{1

7}, Daniel Scherr^{1

8}, Julia Meier⁸, Arian Sultan⁹, Daniel Steven⁹, Elena Terentieva⁹, Ron Pisters¹⁰, Martin Hemels^{7

10}, Leonard Voorhout¹⁰, Piotr Lodziński³, Bartosz Krzowski³, Dhiraj Gupta¹¹, Nikola Kozhuharov^{11

12}, Henri Gruwez^{13

14}, Kevin Vernooy¹, Nikki A H A Pluymaekers¹, Jeroen M Hendriks^{15

16}, Martin Manninger⁸, David Duncker⁴, Dominik Linz^{1

7

16

17}

Affiliations

¹ Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
² Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.
³ 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
⁴ Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
⁵ Barts Heart Center, St Bartholomew's Hospital, London, United Kingdom.
⁶ Department of Cardiology, King George Hospital, Ilford, United Kingdom.
⁷ Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands.
⁸ Department of Cardiology, University Clinic of Medicine, Medical University of Graz, Graz, Austria.
⁹ Department of Electrophysiology, University of Cologne, Heart Center, Cologne, Germany.
¹⁰ Department of Cardiology, Rijnstate Hospital, Arnhem, Netherlands.
¹¹ Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
¹² Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
¹³ Department of Cardiology, Hospital East-Limburg, Genk, Belgium.
¹⁴ Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.
¹⁵ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
¹⁶ Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia.
¹⁷ Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Abstract

Introduction: The TeleCheck-AF approach is an on-demand mobile health (mHealth) infrastructure incorporating mobile app-based heart rate and rhythm monitoring through teleconsultation. We evaluated feasibility and accuracy of self-reported mHealth-based AF risk factors and CHA₂DS₂-VASc-score in atrial fibrillation (AF) patients managed within this approach.

Materials and methods: Consecutive patients from eight international TeleCheck-AF centers were asked to complete an app-based 10-item questionnaire related to risk factors, associated conditions and CHA₂DS₂-VASc-score components. Patient's medical history was retrieved from electronic health records (EHR).

Results: Among 994 patients, 954 (96%) patients (38% female, median age 65 years) completed the questionnaire and were included in this analysis. The accuracy of self-reported assessment was highest for pacemaker and anticoagulation treatment and lowest for heart failure and arrhythmias. Patients who knew that AF increases the stroke risk, more often had a 100% or ≥80% correlation between EHR- and app-based results compared to those who did not know (27 vs. 14% or 84 vs. 77%, P = 0.001). Thromboembolic events were more often reported in app (vs. EHR) in all countries, whereas higher self-reported hypertension and anticoagulant treatment were observed in Germany and heart failure in the Netherlands. If the app-based questionnaire alone was used for clinical decision-making on anticoagulation initiation, 26% of patients would have been undertreated and 6.1%-overtreated.

Conclusion: Self-reported mHealth-based assessment of AF risk factors is feasible. It shows high accuracy of pacemaker and anticoagulation treatment, nevertheless, displays limited accuracy for some of the CHA₂DS₂-VASc-score components. Direct health care professional assessment of risk factors remains indispensable to ensure high quality clinical-decision making.

Keywords: atrial fibrillation; mobile health; photoplethysmography; risk factors; thromboembolic risk.

Copyright © 2022 Hermans, Gawałko, Hillmann, Sohaib, van der Velden, Betz, Verhaert, Scherr, Meier, Sultan, Steven, Terentieva, Pisters, Hemels, Voorhout, Lodziński, Krzowski, Gupta, Kozhuharov, Gruwez, Vernooy, Pluymaekers, Hendriks, Manninger, Duncker and Linz.