Digital follow-up program for patients undergoing atrial fibrillation ablation: a pilot single-center study

Abstract

Abstract Introduction Atrial fibrillation (AF) carries significant burden in health expenditure worldwide. Digital health technology may improve healthcare delivery, but its applicability in clinical practice and related outcomes remain a gap in evidence. Aim To report the implementation of a digital follow-up program (FUP) for patients submitted to AF ablation in an European center. Methods A digital FUP was implemented at a high-volume ablation center in 2020. The program featured a web platform for professionals, to record Clinician Reported Outcome Measurements (CROMs), during remote medical visits, and access Patient Reported Outcomes Measurements (PROMs). The program also included a mobile app for patients to report symptoms, vital signs, anthropometric and electrocardiographic data. Patients were invited to complete questionnaires at prespecified timepoints: Atrial Fibrillation Effect on qualiTy-of-life [AFEQT]; the Epworth and STOP-BANG for obstructive sleep apnea; nutritional questionnaire. Completeness rate was defined by the ratio of queries completed/queries sent at each timepoint. The mHealth App Usability Questionnaire (MAUQ) questionnaire was sent to patients and doctors; patients also received a Patient Reported Experience Measure (PREMs) 15 days after the ablation, from which a Net Promotor Score (NPS, -100 to 100) was calculated to express user’s satisfaction. This retrospective analysis includes data collected from December 2020 to September 2022. Results From the 305 ablations performed in this period, 253 patients were enrolled in the digital FUP: age 60±11 years, 67% male, 78% paroxysmal AF, body mass index 27.4±4.2 kg/m2. During a mean follow-up time of 11.9±5.8 months, 1120 CROMs were registered; 1449 PROMs were collected, including 5865 metrics reported by 90 different patients. App usage, measured by unique logins/month, was recorded in 54% of patients, of whom 13% submitted symptom checks weekly. 160 PREMs were registered; NPS scores for ablation and the app were 85.5 and 31.5, respectively [image]. Questionnaire overall completeness rate was: 54.5% for AFEQT; 14.4% for Epworth; 20.8% for STOP-BANG, that identified 55% of patients at high risk for sleep apnea. Nutritional assessment was completed by 18.7%; obese/pre-obese status was found in 21% and 48%, respectively; 18 patients were enrolled in a nutritional program. All doctors "agreed"/"strongly agreed" to overall satisfaction with the app. Conclusions The digital FUP was feasible and aided comorbidities assessment. Strategies to improve patient’s engagement and digital literacy are warranted. Further studies are needed to evaluate the platform’s impact on clinical outcomes.