Mobile health applications for managing atrial fibrillation for healthcare professionals and patients: a systematic review

Abstract

Aims A plethora of mobile health applications (m-health apps) to support healthcare are available for both patients and healthcare professionals (HCPs) but content and quality vary considerably and few have undergone formal assessment. The aim is to systematically review the literature on m-health apps for managing atrial fibrillation (AF) that examine the impact on knowledge of AF, patient and HCP behaviour, patients’ quality-of-life, and user engagement. Methods and results MEDLINE, EMBASE, CINAHL, and PsychInfo were searched from 1 January 2005 to 5 September 2019, with hand-searching of clinical trial registers and grey literature. Studies were eligible for inclusion if they reported changes in any of the following: (i) knowledge of AF; (ii) provider behaviour (e.g. guideline adherence); (iii) patient behaviour (e.g. medication adherence); (iv) patient quality-of-life; and (v) user engagement. Two reviewers independently assessed articles for eligibility. A narrative review was undertaken as included studies varied widely in their design, interventions, comparators, and outcomes. Seven studies were included; six m-health apps aimed at patients and one at HCPs. Mobile health apps ranged widely in design, features, and method of delivery. Four studies reported patient knowledge of AF; three demonstrated significant knowledge improvement post-intervention or compared to usual care. One study reported greater HCP adherence to oral anticoagulation guidelines after m-health app implementation. Two studies reported on patient medication adherence and quality-of-life; both showed improved quality-of-life post-intervention but only one observed increased adherence. Regarding user engagement, five studies reported patient perspectives on usability, three on acceptability, and one on feasibility; overall all m-health apps were rated positively. Conclusion Mobile health apps demonstrate improvements in patient knowledge, behaviour, and quality of life. Studies formally evaluating the impact of m-health on HCP behaviour are scarce and larger-scale studies with representative patient cohorts, appropriate comparators, and longer-term assessment of the impact of m-health apps are warranted.

One‐year Follow‐up Results of the Optimal Thromboprophylaxis in Elderly Chinese Patients with Atrial Fibrillation (ChiOTEAF) registry

“…Among the mAFA group, lower rates of OAC‐related bleeding (due to the mitigation of modifiable bleeding risk factors) and an increase in the use of OAC (from 63.4% to 70.2%) was observed as compared to standard care 45 . Indeed, implementing digital healthcare models into holistic care pathways of patients with AF may improve patients awareness and treatment acceptance, resulting in better outcomes and OACs compliance 46‐48 …”

“… 45 Indeed, implementing digital healthcare models into holistic care pathways of patients with AF may improve patients awareness and treatment acceptance, resulting in better outcomes and OACs compliance. 46 , 47 , 48 …”

Risk factor management of atrial fibrillation using mHealth: The Atrial Fibrillation – Helping Address Care with Remote Technology (AF-HEART) Pilot Study

“…The potential application of mobile health-based strategies such as the AF-HEART pilot trial extends to using this intervention across geographic distances that traditionally serve as barriers to care, thereby modifying and improving traditional AF risk factors including weight loss, while also improving AF-related symptoms and QOL parameters. Another review demonstrated improved patient knowledge of AF, adherence to medications, and quality of life for patients who used mHealth in AF (56). Therefore, addressing AF risk factors, symptoms, and QOL via mHealth and telehealth utilization, in conjunction with a rhythm-control strategy, promises to help improve the overall morbidity of AF disease, including symptoms as well as even mortality (57).…”

Patient perspectives of the Self-management and Educational Technology tool for Atrial Fibrillation (SETAF): A mixed-methods study in Singapore

“…On the other hand, reading ability also plays a vital role in health literacy [11]. mHealth interventions should not only ensure scientifically validated content but also be tailored to the literacy levels of their users to maximize its benefits [11,25].…”

“…mHealth technology has the potential to help address these issues by remote monitoring, patient education, promoting adherence to medications and healthier lifestyle behaviors. There is growing evidence of the positive effects from use of mHealth in the management of AF which can increase quality of life, AF knowledge, medication adherence and decreased emergency department visits [11,12]. However, it is important to consider the contextual background of patient preferences, usability and acceptance of such technology in order to overcome barriers to use and promote medium to long term user engagement.…”