Education-based integrated care for atrial fibrillation, including use of a new App. Patient perspectives and secondary health outcomes

Abstract

Affecting 2-3% of adults in Europe, atrial fibrillation (AF) is the most common arrhythmia. The prevalence of this chronic disease is anticipated to double globally in the next decades. With a high burden on patients, healthcare providers, and the healthcare system, optimal AF management has been the subject of substantial research in recent years. This led, among other things, to the development of the ABC pathway (Avoid stroke, Better symptom management, and Cardiovascular and comorbidity risk factor reduction) as a useful guideline for healthcare providers. Also, more attention was given to the broader picture, including patient-centered care and the involvement of other specialists, to organize a coordinated, effective AF treatment and follow-up called ‘Integrated AF care’. Clinical trials, which, however, comprised various patient populations and diverse methodologies, yielded no conclusive evidence in favor of the intervention, highlighting the difficulty of establishing and delivering integrated care for AF patients. In addition, access to laptops, smartphones, and smartwatches is also increasing in the population over 65 years, the typical AF population. About 83% of the Belgian 65+ age population has a smartphone. This digital expansion carries the opportunity to promote and enable better healthcare delivery through increased engagement between patients and healthcare professionals.

This doctoral thesis aimed to provide a new concept of ‘integrated care through education’, the AF-EduCare approach, to a broad AF population. It wants to assess which components contribute to improved AF care and what are the patients’ experiences. With the upcoming use of mHealth, its usability was evaluated in different parts of this thesis, with three main aspects: (I) the implementation of the AF-EduCare approach in an in-house developed application, (II) the effect of that approach on knowledge level, self-care capabilities, therapy adherence to oral anticoagulation (OAC) and symptom burden, and (III) patients’ experience with the delivered education-based care and patients’ use of the counseling aspect of the AF-EduCare approach.

The AF-EduCare approach is based on four main pillars: (1) patient education about the arrhythmia and its treatment as the cornerstone to ensuring patient involvement and commitment, (2) assessment of AF risk factors and education on how to manage those, (3) improving adherence to OAC therapy and (4) providing an easy pathway for patients to ask questions to a specialized AF team. These four pillars were also included in the in-house developed AF-EduApp. The six main modules were (I) an education module with information on AF, (II) a questionnaire module including targeted education based on given answers, (III) a medication module with reminders, (IV) a measurement module to enter clinical parameters (e.g. heart rate, weight), (V) an appointment module, and (VI) a module to ask questions to the AF team. Three different education strategies were assessed, i.e. In-person, Online, or App-based education, and compared with standard care (i.e. usual treatment approach used in the hospital, SC).