Usability and Perceived Usefulness of the AFib 2gether Mobile App in a Clinical Setting: Single-Arm Intervention Study (Preprint)

Abstract

BACKGROUND Although the American Heart Association and other professional societies have recommended shared decision-making as a way for patients with atrial fibrillation or flutter (AF) to reach informed decisions about using anticoagulation (AC), the best method of facilitating shared decision-making remains uncertain. OBJECTIVE The aim of this study is to assess the AFib 2gether™ mobile app for usability, perceived usefulness, and extent and nature of shared decision making that occurred for clinical encounters between patients with AF and their cardiology providers in which the app was used. METHODS We identified patients coming to see a cardiology provider from October 2019 until May 2020. We measured usability from patients and providers through the mobile app rating scale (MARS). From the eight items of the MARS, we report the average score (out of 5) for domains of functionality, aesthetics, and overall quality. We administered a three-item questionnaire to patients relating to their perceived usefulness and a separate three-item questionnaire to providers to measure their perceived usefulness. We performed a chart review to track AC starts occurring within 6 months of the index visit. We also audio-recorded a subset of encounters to identify evidence of shared decision-making. RESULTS We facilitated shared decision-making visits for 37 patients seeing 13 providers. In terms of usability, patients’ ratings of functionality, aesthetics, and overall quality were (average ± standard deviation): 4.51 ± 0.61, 4.26 ± 0.51, and 4.24 ± 0.89, respectively. In terms of usefulness, 40% of patients agreed that the app improved their knowledge regarding AC and 62% agreed that the app helped clarify to their provider, their preferences regarding AC. Among providers, 79% agreed that the app helped clarify their patients’ preferences; 82% agreed that the app saved them time; and 59% agreed that the app helped their patients make decisions about AC. Additionally, 12 patients started AC after their shared decision-making visits. We audio-recorded 25 encounters. Of these encounters, 84% included mention of AC for AF, 44% included discussion of multiple options for AC, 72% included a provider recommendation for AC, and 48% included evidence of patient involvement in the discussion. CONCLUSIONS Patients and providers rated the app with high usability and perceived usefulness. Moreover, a third of patients began AC and in nearly ½ the encounters, there was evidence of patient involvement in decision-making. In the future, we plan to study the effect of the app in a larger sample and with a controlled study design. CLINICALTRIAL ClinicalTrials.gov NCT04118270. INTERNATIONAL REGISTERED REPORT RR2-21986

A novel shared decision-making (SDM) tool for anticoagulation management in atrial fibrillation: protocol for a prospective, multicenter, cluster randomized controlled trial

“…Several mobile health tools have been developed to manage AF patients, including the AFib 2gether™ app [14] that facilitates SDM for patients who are not receiving anticoagulation therapy, and another SDM tool [30]that provides individualized stroke risk estimates for different anticoagulation therapy options. However, most of these tools are based on international studies that have limited representation of Asian and Chinese participants, despite the higher risks of stroke and bleeding in Asian AF patients [31].…”

“…This approach is now recommended as a class I recommendation for patient management in clinical guidelines for AF [1]. Although several online tools have been developed to facilitate SDM in AF patients [13][14][15][16], most of them use outdated or nonspecific data and lack support for full-process follow-up, making it challenging to achieve optimal individualization of anticoagulation and sustainable management [16]. In response to these challenges, our team developed a SDM tool called I-Anticoagulation, which comprises two functional modules -an anticoagulation decision support system and a full-process patient management system -to enhance the decision-making and patient management of stroke prevention in AF [17].…”