scholarly journals On-Demand Mobile Health Infrastructure for Remote Rhythm Monitoring within a Wait-and-See Strategy for Recent-Onset Atrial Fibrillation: TeleWAS-AF

Cardiology ◽  
2021 ◽  
pp. 1-5
Author(s):  
Nikki A.H.A. Pluymaekers ◽  
Rachel M.J. van der Velden ◽  
Astrid N.L. Hermans ◽  
Monika Gawalko ◽  
Saskia Buskes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Mobile Health ◽  
Treatment Decision ◽  
Care Process ◽  
Care Utilization ◽  
Recent Onset ◽  
On Demand ◽  
Wait And See ◽  
Rhythm Monitoring

Recently, we introduced the TeleCheck-AF approach, an on-demand mobile health (mHealth) infrastructure using app-based heart rate and rhythm monitoring for 7 days, to support long-term atrial fibrillation (AF) management through teleconsultation. Herein, we extend the mHealth approach to patients with recent-onset AF at the emergency department (ED). In the proposed TeleWAS-AF approach, on-demand heart rate and rhythm monitoring are used to support a wait-and-see strategy at the ED. All stable patients who present to the ED with recent-onset symptomatic AF and who are able to use mHealth solutions for heart rate and rhythm monitoring are eligible for this approach. Patients will receive both education on AF and instructions on the use of the mHealth technology before discharge from the ED. A case coordinator will subsequently check whether patients are able to activate the mHealth solution and to perform heart rate and rhythm measurements. Forty hours after AF onset, the first assessment teleconsultation with the physician will take place, determining the need for delayed cardioversion. After maximal 7 days of remote monitoring, a second assessment teleconsultation may occur, in which the rhythm can be reassessed and further treatment strategy can be discussed with the patients. This on-demand mHealth prescription increases patient involvement in the care process and treatment decision-making by encouraging self-management, while avoiding excess data-load requiring work-intensive and expensive data management. Implementation of the TeleWAS-AF approach may facilitate the management of AF in the ED and reduce the burden on the ED system, which enhances the capacity for health care utilization.

scholarly journals Implementation of an on-demand app-based heart rate and rhythm monitoring infrastructure for the management of atrial fibrillation through teleconsultation: TeleCheck-AF

EP Europace ◽  
2020 ◽  
Author(s):  
Nikki A H A Pluymaekers ◽  
Astrid N L Hermans ◽  
Rachel M J van der Velden ◽  
Monika Gawałko ◽  
Dennis W den Uijl ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Integrated Care ◽  
Mobile Health ◽  
Multidisciplinary Team ◽  
Care Process ◽  
Mhealth Intervention ◽  
On Demand ◽  
Outpatient Visits ◽  
Rhythm Monitoring

Abstract During the coronavirus 2019 (COVID-19) pandemic, outpatient visits in the atrial fibrillation (AF) clinic of the Maastricht University Medical Centre (MUMC+) were transferred into teleconsultations. The aim was to develop an on-demand app-based heart rate and rhythm monitoring infrastructure to allow appropriate management of AF through teleconsultation. In line with the fundamental aspects of integrated care, including actively involving patients in the care process and providing comprehensive care by a multidisciplinary team, we implemented a mobile health (mHealth) intervention to support teleconsultations with AF patients: TeleCheck-AF. The TeleCheck-AF approach guarantees the continuity of comprehensive AF management and supports integrated care through teleconsultation during COVID-19. It incorporates three important components: (i) a structured teleconsultation (‘Tele’), (ii) a CE-marked app-based on-demand heart rate and rhythm monitoring infrastructure (‘Check’), and (iii) comprehensive AF management (‘AF’). In this article, we describe the components and implementation of the TeleCheck-AF approach in an integrated and specialized AF-clinic through teleconsultation. The TeleCheck-AF approach is currently implemented in numerous European centres during COVID-19.

Coordination of a remote mHealth infrastructure for atrial fibrillation management during COVID-19 and beyond: TeleCheck-AF

2020 ◽  
Vol 23 (2-3) ◽  
pp. 65-70 ◽  
Author(s):  
Rachel MJ van der Velden ◽  
Astrid NL Hermans ◽  
Nikki AHA Pluymaekers ◽  
Monica Gawalko ◽  
Bianca Vorstermans ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Mobile Health ◽  
Multidisciplinary Team ◽  
Mhealth Intervention ◽  
On Demand ◽  
Outpatient Visits ◽  
Care Processes ◽  
Multiple Levels ◽  
Rhythm Monitoring

During the coronavirus 2019 (COVID-19) pandemic, outpatient visits for patients with atrial fibrillation (AF), were converted into teleconsultations. As a response to this, a novel mobile health (mHealth) intervention was developed to support these teleconsultations with AF patients: TeleCheck-AF. This approach incorporates three fundamental components: 1) “Tele”: A structured teleconsultation. 2) “Check”: An app-based on-demand heart rate and rhythm monitoring infrastructure. 3) “AF”: comprehensive AF management. This report highlights the significant importance of coordination of the TeleCheck-AF approach at multiple levels and underlines the importance of streamlining care processes provided by a multidisciplinary team, using an mHealth intervention, during the COVID-19 pandemic. Moreover, this report reflects on how the TeleCheck-AF approach has contributed to strengthening the health system in maintaining management of this prevalent sustained cardiac arrhythmia, whilst keeping patients out of hospital, during the pandemic and beyond.

scholarly journals On-demand app-based rate and rhythm monitoring to manage atrial fibrillation through teleconsultations during COVID-19

2020 ◽  
Vol 28 ◽  
pp. 100533 ◽  
Author(s):  
Nikki A.H.A. Pluymaekers ◽  
Astrid N.L. Hermans ◽  
Rachel M.J. van der Velden ◽  
Dennis W. den Uijl ◽  
Bianca Vorstermans ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
On Demand ◽  
Rhythm Monitoring

scholarly journals Automatic Mobile Health Arrhythmia Monitoring for the Detection of Atrial Fibrillation: Prospective Feasibility, Accuracy, and User Experience Study

10.2196/29933 ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. e29933
Author(s):  
Onni E Santala ◽  
Jari Halonen ◽  
Susanna Martikainen ◽  
Helena Jäntti ◽  
Tuomas T Rissanen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mobile Phone ◽  
Monitoring System ◽  
Sensitivity And Specificity ◽  
User Experience ◽  
Mobile Health ◽  
Visual Interpretation ◽  
Arrhythmia Detection ◽  
Mobile Phone Application ◽  
Rhythm Monitoring

Background Atrial fibrillation (AF) is the most common tachyarrhythmia and associated with a risk of stroke. The detection and diagnosis of AF represent a major clinical challenge due to AF’s asymptomatic and intermittent nature. Novel consumer-grade mobile health (mHealth) products with automatic arrhythmia detection could be an option for long-term electrocardiogram (ECG)-based rhythm monitoring and AF detection. Objective We evaluated the feasibility and accuracy of a wearable automated mHealth arrhythmia monitoring system, including a consumer-grade, single-lead heart rate belt ECG device (heart belt), a mobile phone application, and a cloud service with an artificial intelligence (AI) arrhythmia detection algorithm for AF detection. The specific aim of this proof-of-concept study was to test the feasibility of the entire sequence of operations from ECG recording to AI arrhythmia analysis and ultimately to final AF detection. Methods Patients (n=159) with an AF (n=73) or sinus rhythm (n=86) were recruited from the emergency department. A single-lead heart belt ECG was recorded for 24 hours. Simultaneously registered 3-lead ECGs (Holter) served as the gold standard for the final rhythm diagnostics and as a reference device in a user experience survey with patients over 65 years of age (high-risk group). Results The heart belt provided a high-quality ECG recording for visual interpretation resulting in 100% accuracy, sensitivity, and specificity of AF detection. The accuracy of AF detection with the automatic AI arrhythmia detection from the heart belt ECG recording was also high (97.5%), and the sensitivity and specificity were 100% and 95.4%, respectively. The correlation between the automatic estimated AF burden and the true AF burden from Holter recording was >0.99 with a mean burden error of 0.05 (SD 0.26) hours. The heart belt demonstrated good user experience and did not significantly interfere with the patient’s daily activities. The patients preferred the heart belt over Holter ECG for rhythm monitoring (85/110, 77% heart belt vs 77/109, 71% Holter, P=.049). Conclusions A consumer-grade, single-lead ECG heart belt provided good-quality ECG for rhythm diagnosis. The mHealth arrhythmia monitoring system, consisting of heart-belt ECG, a mobile phone application, and an automated AF detection achieved AF detection with high accuracy, sensitivity, and specificity. In addition, the mHealth arrhythmia monitoring system showed good user experience. Trial Registration ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335

scholarly journals Timing of cardioversion in atrial fibrillation: the sooner the better?

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L41-L43
Author(s):  
Piera Capranzano ◽  
Valeria Calvi
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Rate Control ◽  
Limited Resources ◽  
Psychological Burden ◽  
Treatment Pathway ◽  
Recent Onset ◽  
Wait And See ◽  
Costs Of Treatment ◽  
Spontaneous Conversion

Abstract Management of recent-onset (<36 h) atrial fibrillation (AF) in the emergency room is highly variable, particularly concerning the type and timing of cardioversion, and the logistics of the treatment pathway. In clinical practice, it is fairly common for patients with recent-onset AF an attempt at re-establishing sinus rhythm, either with electric or pharmacologic cardioversion, as soon as feasible. Nonetheless, a ‘wait-and-see’ approach, and potentially delayed cardioversion, could represent a valid alternative to early cardioversion, considering that, often, in recent-onset AF, sinus rhythm is re-established spontaneously, thus repealing the need for active cardioversion, hence avoiding the possible risks of treatment. These concepts form the rationale for a recent multicentric randomized trial, Rate Control vs. Electrical Cardioversion Trial 7 – Acute Cardioversion vs. Wait and See (RACE 7 ACWAS), comparing the efficacy of delayed cardioversion, within 48 h from symptoms onset, in case of lack of spontaneous conversion, with early cardioversion in symptomatic patients with recent-onset AF. In patients presenting to the emergency department with recent-onset, symptomatic AF, a wait-and-see approach was non-inferior to early cardioversion in maintaining the sinus rhythm at 4 weeks. Nonetheless a system employing a delayed cardioversion strategy increases the costs of treatment, complicates the treatment pathway, and could represent a psychological burden for the patients. Accordingly, delayed cardioversion could not represent a practical choice for many hospitals with limited resources and without an adequate outpatient organization.

scholarly journals Can we safely use a wait and see approach for patients with recent onset atrial fibrillation?

CJEM ◽  
2019 ◽  
Vol 21 (6) ◽  
pp. 715-716
Author(s):  
Saahil Vij ◽  
Amy Burton ◽  
Heather Murray ◽  
Melanie Walker
Keyword(s):  
Atrial Fibrillation ◽  
Recent Onset ◽  
Wait And See ◽  
Onset Atrial Fibrillation

scholarly journals On‐demand mobile health infrastructures to allow comprehensive remote atrial fibrillation and risk factor management through teleconsultation

2020 ◽  
Vol 43 (11) ◽  
pp. 1232-1239 ◽  
Author(s):  
Astrid N. L. Hermans ◽  
Rachel M. J. Velden ◽  
Monika Gawalko ◽  
Dominique V. M. Verhaert ◽  
Lien Desteghe ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Mobile Health ◽  
Risk Factor Management ◽  
On Demand

scholarly journals The TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: Patient experiences

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
D Linz ◽  
N Pluymaekers ◽  
D Duncker ◽  
M Manninger ◽  
R Van Der Velden ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Rate ◽  
Patient Adherence ◽  
Care Delivery ◽  
Patient Characteristics ◽  
Median Number ◽  
Patient Experiences ◽  
Funding Sources ◽  
The Future ◽  
Rhythm Monitoring

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf TeleCheck-AF Investigators Aims TeleCheck-AF is a multicentre international project initiated to maintain care delivery for patients with atrial fibrillation (AF) during COVID-19 through teleconsultations supported by an on-demand photoplethysmography-based heart rate and rhythm monitoring app (FibriCheck®). We describe the characteristics and experiences from recruited patients. Methods Self-reported patient characteristics were obtained from the app. A survey exploring patient experiences completed by 826 patients.  Results Within 28 weeks, 1930 AF patients were recruited by 38 centers in 14 countries, mainly for remote AF control (31% of patients) and AF ablation follow-up (42%). One-third of patients was in the age range 60-69 years. The most common comorbidity was hypertension (42% of all patients). More than 70% of patients were treated with oral anticoagulation. In total 59.858 heart rate and rhythm measurements were recorded. During the one-week FibriCheck® use, patient adherence was high. Patients performed between 2 and 5 recordings a day and the median number of measurements per patient was 21 [15-29]. The highest average number of measurements per patient was seen in patients older than 80years of age. Patients agreed that the FibriCheck® app was easy to use (94%) and easy to install (89%). The app gave patients a safe feeling (74%) due to being in constant heart rate and rhythm control. More than half of the patients (58%) agreed or strongly agreed that they would like to use the FibriCheck® app in the future. They also found the automated reminders useful (64%).  Conclusions In the TeleCheck-AF project, mHealth adherence was high, particularly in older patients ≥80 years. The app FibriCheck® is easy to use for 7 days before a scheduled teleconsultation. Patients think that remote rate and rhythm monitoring around teleconsultation by the TeleCheck-AF approach may be an alternative to traditional face-to-face consultations in the future. Abstract Figure.

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