Mobile Health Technology for Atrial Fibrillation Management Integrating Decision Support, Education, and Patient Involvement: mAF App Trial

Guo, Yutao; Chen, Yundai; Lane, Deirdre A.; Liu, Lihong; Wang, Yutang; Lip, Gregory Y.H.

doi:10.1016/j.amjmed.2017.07.003

Cited by 179 publications

(253 citation statements)

References 32 publications

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“…Recently, several such tools have been developed specifically for AF, and preliminary data suggest a potential for improving AF management and patient outcomes using these tools. 5,23,24 Importantly, their output strongly depends on comprehensiveness (and accuracy) of AF-related and other health information entered for a given patient.…”

Section: Thrombosis and Haemostasismentioning

confidence: 99%

The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

et al. 2020

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Atrial fibrillation (AF) is a complex condition requiring holistic management with multiple treatment decisions about optimal thromboprophylaxis, symptom control (and prevention of AF progression), and identification and management of concomitant cardiovascular risk factors and comorbidity. Sometimes the information needed for treatment decisions is incomplete, as available classifications of AF mostly address a single domain of AF (or patient)-related characteristics. The most widely used classification of AF based on AF episode duration and temporal patterns (that is, the classification to first-diagnosed, paroxysmal, persistent/long-standing persistent, and permanent AF) has contributed to a better understanding of AF prevention and treatment but its limitations and the need for a multidimensional AF classification have been recognized as more complex treatment options became available. We propose a paradigm shift from classification toward a structured characterization of AF, addressing specific domains having treatment and prognostic implications to become a standard in clinical practice, thus aiming to streamline the assessment of AF patients at all health care levels facilitating communication among physicians, treatment decision-making, and optimal risk evaluation and management of AF patients. Specifically, we propose the 4S-AF structured pathophysiology-based characterization (rather than classification) scheme that includes four AF- and patient-related domains—Stroke risk, Symptoms, Severity of AF burden, and Substrate severity—and provide a hypothetical model for the use of 4S-AF characterization scheme to aid treatment decision making concerning the management of patients with AF in clinical practice.

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Section: Thrombosis and Haemostasismentioning

confidence: 99%

The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

et al. 2020

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“…GRADE: Strong; Evidence: High. ► Practice point : Integrated care focuses on three fundamental aspects: multidisciplinary teams, patient‐centred care with a focus on shared decision making, and application of eHealth 48 , 49 All patients prescribed pharmacotherapy for the management of AF, including core rhythm control and anticoagulation therapies, should have their treatment adherence and persistence regularly monitored and supported using accessible and patient‐centred strategies.…”

Section: Key Evidence‐based Recommendationsmentioning

confidence: 99%

Section: Key Evidence‐based Recommendationsmentioning

confidence: 99%

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018

Brieger

Amerena

Attia

et al. 2018

Medical Journal of Australia

110

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Introduction: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work‐up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care. Changes in management as a result of the guideline: Opportunistic screening in the clinic or community is recommended for patients over 65 years of age. The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is highlighted. β‐Blockers or non‐dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control. Cardioversion remains first line choice for acute rhythm control when clinically indicated. Flecainide is preferable to amiodarone for acute and chronic rhythm control. Failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation. The sexless CHA2DS2‐VA score is recommended to assess stroke risk, which standardises thresholds across men and women; anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2. If anticoagulation is indicated, non‐vitamin K oral anticoagulants are recommended in preference to warfarin. An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available. Regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur.

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“…26 As the population ages and CVD becomes more common, these types of mHealth applications could be of particular utility in older adults. A list of selected studies 11,[13][14][15][16][17][18]20,21,23,24,[26][27][28][29][30][31][32][33][34][35][36][37][38][39] regarding mHealth in this domain that may be relevant to older adults is provided in Table 1. The remainder of this narrative review will focus on mHealth cardiac rehabilitation (mHealth-CR) in older patients, which represents a particularly attractive target for intervention.…”

Section: Applications Of Mhealth In Older Adults: An Overviewmentioning

confidence: 99%

Mobile health and cardiac rehabilitation in older adults

Bostrom

Sweeney

Whiteson

et al. 2019

Clinical Cardiology

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With the ubiquity of mobile devices, the availability of mobile health (mHealth) applications for cardiovascular disease (CVD) has markedly increased in recent years. Older adults represent a population with a high CVD burden and therefore have the potential to benefit considerably from interventions that utilize mHealth. Traditional facility‐based cardiac rehabilitation represents one intervention that is currently underutilized for CVD patients and, because of the unique barriers that older adults face, represents an attractive target for mHealth interventions. Despite potential barriers to mHealth adoption in older populations, there is also evidence that older patients may be willing to adopt these technologies. In this review, we highlight the potential for mHealth uptake for older adults with CVD, with a particular focus on mHealth cardiac rehabilitation (mHealth‐CR) and evidence being generated in this field.

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Mobile Health Technology for Atrial Fibrillation Management Integrating Decision Support, Education, and Patient Involvement: mAF App Trial

Cited by 179 publications

References 32 publications

The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018

Mobile health and cardiac rehabilitation in older adults

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