Managing diagnosed AF patients

The purpose of this study was to assess the feasibility of repeated on-demand heart rhythm and symptom monitoring and analyze time spent with AF and symptoms over 12 months after AF ablation.

Repeated on-demand smartphone-based monitoring is feasible after AF ablation. Patient adherence declined slightly over 12 months. At 3 months, high AF and symptom load reliably predicted the following year while low AF and symptom load necessitate repeated monitoring.

Reduction of atrial fibrillation (AF) burden is the preferred outcome measure over categorical AF rhythm recurrence after AF ablation. In this sub-analysis of the TeleCheck-AF project, we tested the feasibility of smartphone app-based approximation of time spent with AF and/or symptoms.

On-demand, app-based simultaneous rhythm and symptom assessment provides objective proxies of time spent with AF and/or symptoms and SRC, which may assist in assessing AF and symptom outcomes after AF ablation.

To compare the effectiveness of digital follow-up utilizing a PPG-based smartphone application with conventional ECG-based follow-up for the detection of atrial arrhythmia recurrence after ablation.

Among patients with AF ablation, digital PPG-based rhythm monitoring with a smartphone, was non-inferior in the detection of atrial arrhythmia recurrence after ablation. Moreover, the detection of atrial arrhythmia was significantly increased compared to conventional ECG-based monitoring.

Direct current cardioversion (DCCV) is a commonly utilised rhythm control technique for atrial fibrillation (AF). Follow-up typically comprises a hospital visit for 12-lead ECG two weeks post-DCCV. We report the feasibility, costs and environmental benefit of remote photoplethysmography (PPG) monitoring as an alternative.

Remote PPG monitoring is a viable method of assessing for arrhythmia recurrence post-DCCV. This approach may save patients significant travel time, reduce environmental CO2 emission and be cost saving in a publicly-funded healthcare system.

To provide insights into the promise of integrating digital health and remote monitoring into AF management via a virtual ward model.

This study indicates that the virtual ward model enabled patients to be effectively triaged remotely, allowed health deteriorations to be recognised early, ensuring patients received timely medical attention or emergency care, and reduced the likelihood of subsequent ED reattendances on discharge. It also demonstrates the potential cost effectiveness of the model through readmission avoidance and early supported discharge of stable hospitalised AF patients, who might otherwise have had a longer inpatient stay. This pilot study provides valuable insights into the promise of integrating digital health and remote monitoring into AF management via a virtual ward model.

To evaluate changes in healthcare utilisation and comprehensive packages of care activities and procedures (referred in the Netherlands to as ‘diagnose-behandelcombinatie (DBC) care products) during the implementation of the TeleCheck-AF approach (teleconsultation supported by app-based heart rate/rhythm monitoring) in a Dutch atrial fibrillation (AF) clinic.

The implementation of TeleCheck-AF was associated with a change in health care utilisation and a disproportional decrease in reimbursement by health insurers due to a change from medium-weight to light-weight DBC care products. Its implementation decreased the potential burden on patients caused by, for example, travel costs and time investment. These results were used as the basis for the development of a new optional reimbursement code for the TeleCheck-AF approach in the Netherlands. This example can serve as a roadmap for future development of digital AF care reimbursement models in the Netherlands and worldwide. 

Prolonged photoplethysmography-based heart rhythm monitoring in patients undergoing re-ablation of atrial fibrillation - compliance, motivation, and experience

Technical advances in photoplethysmography (PPG) utilizing smartphones have led to the capability of domestic heart rhythm monitoring (HRM). Longitudinal HRM after catheter ablation of atrial fibrillation (AF) may increase the detection rate of AF relapses and improve patient care. However, there is only limited evidence on patients’ motivation, compliance, and experience.

Our data show excellent compliance and good motivation as well as good experience with a prolonged smartphone-based HRM in the setting of re-ablation of AF showcasing patients willingness to actively take part in their own care process. This suggests that current standard of care after catheter ablation of AF should be complemented by more intensive HRM involving telemedical approaches.

To determine if the validated smartphone application
FibriCheck, which uses photoplethysmography to detect AF, can
remove the need for in-person monitors, thereby reducing costs.

Using FibriCheck, 12-lead ECGs and Holters were avoided, reducing the burden on primary care, and releasing Holter monitors to patients with higher acuity. This also equated to significant cost
and time savings, allowing for increased efficiency of the service, and making a positive impact on the carbon footprint. FibriCheck allowed safe at-home remote monitoring of symptoms with timely diagnosis, detection, and management of AF recurrence for patients in our post-AF ablation clinics. This is an easily replicated and cost-efficient
service. 

Developing & implementing a digital care pathway for patients with AF using remote monitoring.

To digitize and enhance pre-existing AF care pathways through implementation of an early supported discharge pathway, using an approach that leverages digital remote monitoring technologies. Two digital elements were integrated, being FibriCheck and a digital interface, integrated with the patient electronic health record. A remote monitoring hub, staffed by trained specialist nurses, managed the virtual AF ward environment and conducted telephone triage assessments, escalating to the cardiology team when needed.

Patients can be triaged safely and effectively in virtual AF wards. Out of the patients enrolled, there was 95% patient engagement with remote monitoring with positive patient feedback overall. This approach led to a 4-day shorter length of stay with reduction in rates of rehospitalization, which resulted in significant cost-savings of up to £990 per patient. The findings suggest that this model could be replicated across other NHS trusts, and could lead to improved care delivery, improved patient experience and shorter inpatient stay.

Comparison of pulsed-field ablation versus very high power short duration-ablation for pulmonary vein isolation

Pulsed-field ablation and VHPSD-PVI seem to be highly effective and safe to achieve PVI in the setting of PAF and persAF with comparable arrhythmia-free survival. However, procedure duration for PFA PVI is significantly shorter and therefore may be of potential benefit. Compared to PFA VHPSD-PVI might ensure information on left atrial substrate allowing to target concomitant secondary tachycardias.

Transforming our post-atrial fibrillation ablation follow up patient pathway using FibriCheck:

A smartphone digital app used for remote monitoring

Using FibriCheck, 12-lead ECGs and Holters were avoided, reducing the burden on primary care, and releasing Holter monitors to patients with higher acuity. This also equated to significant cost and time savings, allowing for increased efficiency of the service, and making a positive impact on the carbon footprint. This is an easily replicated and cost-efficient service.

Photoplethysmography-documented atrial fibrillation in the first week after catheter ablation is associated with lower success rates

PPG rhythm telemonitoring during the first week after AF ablation often triggered clinical interventions. Due to its high availability, PPG-based follow-up actively involving patients after AF ablation may close a diagnostic and prognostic gap in the blanking period and increase active patient-involvement.

The implementation of TeleCheck-AF was associated with a change in health care utilisation which resulted in a disproportional drop in reimbursement by health insurances due to a shift in declarable care products weights. Results of this analysis were basis to design a new reimbursement code for the TeleCheck-AF approach in the Netherlands.

The European TeleCheck-AF project on remote app-based management of atrial fibrillation: ablation outpatient clinic experience

The current sub-study of the TeleCheck-AF project aimed to provide the first real-world dataset on feasibility and patient experience of this standardized mobile health (mHealth) infrastructure in the clinical setting of follow-up after catheter ablation.

The TeleCheck-AF approach is feasible and associated with high adherence as well as motivation to use the app and with optimal patient experience. Whether this approach can replace conventional rhythm follow-up after catheter ablation required further study.