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

Abstract

Background Although the American Heart Association and other professional societies have recommended shared decision-making as a way for patients with atrial fibrillation (AF) or atrial flutter to make informed decisions about using anticoagulation (AC), the best method for 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 the 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 visiting a cardiology provider between October 2019 and May 2020. We measured usability from patients and providers using the Mobile App Rating Scale. From the 8 items of the Mobile App Rating Scale, we reported the average score (out of 5) for domains of functionality, esthetics, and overall quality. We administered a 3-item questionnaire to patients relating to their perceived usefulness of the app and a separate 3-item questionnaire to providers to measure their perceived usefulness of the app. We performed a chart review to track the occurrence of AC within 6 months of the index visit. We also audio recorded a subset of the encounters to identify evidence of shared decision-making. Results We facilitated shared decision-making visits for 37 patients visiting 13 providers. In terms of usability, patients’ average ratings of functionality, esthetics, and overall quality were 4.51 (SD 0.61), 4.26 (SD 0.51), and 4.24 (SD 0.89), respectively. In terms of usefulness, 41% (15/37) of patients agreed that the app improved their knowledge regarding AC, and 62% (23/37) agreed that the app helped clarify to their provider their preferences regarding AC. Among providers, 79% (27/34) agreed that the app helped clarify their patients’ preferences, 82% (28/34) agreed that the app saved them time, and 59% (20/34) agreed that the app helped their patients make decisions about AC. In addition, 32% (12/37) of patients started AC after their shared decision-making visits. We audio recorded 25 encounters. Of these, 84% (21/25) included the mention of AC for AF, 44% (11/25) included the discussion of multiple options for AC, 72% (18/25) included a provider recommendation for AC, and 48% (12/25) included the evidence of patient involvement in the discussion. Conclusions Patients and providers rated the app with high usability and perceived usefulness. Moreover, one-third of the patients began AC, and approximately 50% (12/25) of the encounters showed evidence of patient involvement in decision-making. In the future, we plan to study the effect of the app on a larger sample and with a controlled study design. Trial Registration ClinicalTrials.gov NCT04118270; https://clinicaltrials.gov/ct2/show/NCT04118270 International Registered Report Identifier (IRRID) RR2-21986

Smartphone App in Stroke Management: A Narrative Updated Review

“…Another useful App in the management of AF is AFib 2gether mobile App [ 79 , 80 ], which was developed by Pfizer Inc. (New York, NY, USA). It is a helpful tool for sharing decision-making regarding anticoagulation therapy for AF.…”

“…The provider can review the data of the patient as well as any questions the patient solicited in the App for discussion prior to the visit. The aim of this App is to help the patient to do an informed decision about anticoagulation therapy [ 79 , 80 ].…”

“…74 Devices such as belts, 75 miniaturized electrocardiograms (ECGs) associated with smartphone Apps, 8,76 and devices that are placed on the patient's chest have also been used. 77,78 Another useful App in the management of AF is AFib 2gether mobile App, 79,80 which was developed by Pfizer Inc. (New York, NY, USA). It is a helpful tool for sharing decision-making regarding anticoagulation therapy for AF.…”

“…The aim of this App is to help the patient to do an informed decision about anticoagulation therapy. 79,80…”

Smartphone Apps for Managing Antithrombotic Therapy: Scoping Literature Review

“…The protocol of a single-arm intervention study to assess usability and perceived usefulness has been published [ 23 ]. The usability categories of functionality and aesthetics were rated as 4.51 and 4.26 out of 5 by 37 patients and 4.19 and 4.04 out of 5 by 13 physicians, respectively, using the Mobile App Rating Scale [ 24 ]. Perceived usefulness was reported by patients with 40% to 62% agreement and by physicians with 59% to 82% agreement in three categories each.…”