Clinician-created video education for patients with atrial fibrillation: a randomised clinical trial

Abstract

Abstract Background Improved health literacy is associated with better health outcomes.(1) Atrial fibrillation (AF) is a complex condition and patient understanding of AF is poor.(2) There is little time during routine care to provide education on AF. Clinic waiting time provides an opportunity to deliver education that improves AF knowledge and engagement with clinical care. Purpose Assess the efficacy and feasibility of remotely-delivered clinician-created education for patients with AF. Methods Single-centre randomised clinical trial (ANZCTRN 12620000729921, registered 13/07/2020) conducted in adults over 18 years of age awaiting outpatient cardiac clinic appointments with electrocardiogram-confirmed AF, CHA²DS²VASc > 0 and an active electronic mailing address or mobile phone. Those with insufficient English proficiency to comprehend video content were excluded. Eligible participants were recruited remotely and randomised 1:1 to an internet-based intervention of 4 animated videos narrated by treating cardiologists totalling 15 minutes with the option to review videos weekly, or usual care. Recruiting staff, outcome assessors and those responsible for statistical analysis were blinded to treatment allocation. The primary outcome was Jessa AF Knowledge Questionnaire (JAKQ) score (a 16-item validated questionnaire consisting of general AF and anticoagulation-specific questions(2)) at 90 days post recruitment adjusted for baseline performance, AF diagnosis, educational level, age and sex. A sample size of 200, allowing for 15% attrition and a standard deviation of 18 described previously(2) was prospectively calculated to have 90% power (2-sided, type 1 error of 5%) to detect an 8.95% difference in 90-day AF knowledge. Results Between November 2020 and July 2022, 208 patients were randomised (104 intervention, 104 control). Mean (standard deviation) age was 65.0 (12) years, and 65.2% were male. Most (56.2%) had paroxysmal AF and 6.4% had first episode AF. Intervention participants were more likely to correctly answer JAKQ questions at 90 days (odds ratio [OR] 1.23 [95% confidence interval (CI) 1.01, 1.49]). Highly engaged participants were more likely to have higher JAKQ scores (OR 1.46 [95% CI 1.14, 1.88] among those who watched videos on 3 or more weeks compared to control). Video satisfaction was high (figure 2). There was no significant difference in satisfaction with care or education provided in clinic OR 1.32 [95% CI 0.71, 2.44]). Conclusions A clinician-created, low-cost, remotely-delivered educational intervention among patients with AF awaiting cardiac clinic appointments was highly acceptable and improved AF knowledge at 90 days. Increased intervention exposure correlated with higher knowledge scores. Future delivery of this intervention could investigate impact on medication adherence, AF burden, and patient-reported quality of life outcomes.Figure 1Figure 2