- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04076020
Atrial Fibrillation Health Literacy and Information Technology Trial in Rural PA Counties (AFibLITT_R)
November 27, 2023 updated by: Jared W Magnani, MD, MSc, University of Pittsburgh
Mobile Health Intervention for Rural Atrial Fibrillation
Atrial fibrillation (AF) is a highly prevalent, morbid condition.
Anticoagulation to prevent thromboembolic strokes is a foremost priority in AF but adherence is challenging for patients and lapses in anticoagulation are common.
Chronic disease self-management (CDSM) is a recognized program to enhance self-efficacy and improve adherence, quality of life, and patient-centered health outcomes.
Rural patients with AF experience increased vulnerability to adverse outcomes due to geographic and social isolation, poor health care access, and limited health literacy.
This study uses an innovative, scalable CDSM intervention to improve anticoagulation adherence in rural patients with AF.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Detailed Description
This is a randomized clinical trial to evaluate the effect of a smartphone-based intervention called an embodied conversational agent (ECA) on health outcomes in people with atrial fibrillation.
The study will enroll 264 patients who reside in rural, Western Pennsylvania who have atrial fibrillation.
Participants will be randomized to the intervention or control.
Intervention participants will receive a smartphone with a relational agent, which simulates conversation and provides coaching, guidance, and assistance with chronic disease self-management.
In addition participants will receive an AliveCor Kardia for heart rate and rhythm monitoring, an FDA-approved, widely used instrument that pairs with the relational agent.
Control participants will receive a smartphone with as well, which will have the health application WebMD.
The intervention will last 4 months and participants will have visits at baseline, 4, 8 and 12 months.
The study will evaluate the improvement in adherence to anticoagulation, quality of life, and health care utilization resulting from the intervention.
Study Type
Interventional
Enrollment (Actual)
270
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Pennsylvania
-
Pittsburgh, Pennsylvania, United States, 15213
- University of Pittsburgh Medical Center
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
21 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Adult, age ≥18;
- Diagnosis of AF, identified from the EHR problem list and confirmed by 2 or more reports of AF from separate monitoring events at least 2 weeks apart (CG, Holter or event monitor);
- CHA2DS2-VASc (heart failure, hypertension, age, diabetes, prior stroke/TIA, CD, female sex)≥2;
- Prescribed use of warfarin or DOAC (formerly NOAC) for AF stroke prevention;
- English-speaking well enough to participate in informed consent and this study;
- No plans to relocate from the area within 12 months of enrollment.
Exclusion Criteria:
- Conditions other than AF that require anticoagulation, such as mechanical prosthetic valve, deep vein thrombosis, or pulmonary embolism;
- History of pulmonary vein isolation or foreseen pulmonary vein isolation;
- History of AV nodal ablation or foreseen AV nodal ablation;
- Heart failure necessitating hospital admission ≤3 months prior to study inclusion;
- Acute coronary syndrome (defined as at least 2 of the following: chest pain, ischemic electrocardiographic changes, or troponin ≥0.1 ng/mL) ≤3 months prior to study inclusion;
- Untreated hyperthyroidism or ≤3 months euthyroidism before inclusion;
- Foreseen pacemaker, internal cardioverter defibrillator, or cardiac resynchronization therapy;
- Cardiac surgery ≤3 months before inclusion;
- Planned cardiac surgery;
- Presence of non-cardiovascular conditions likely to be fatal within 12 months (e.g., cancer);
- Inability to comprehend the study protocol, defined as failing to answer correctly a set of questions on orientation and short-term memory during the consent process.
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention arm
Receive the relational agent and the AliveCor Kardia for use for 120 days.
Participants are directed to use these interventions daily.
|
Use of the relational agent and Kardia daily for 120 days.
|
Active Comparator: Usual care arm
Receive a brochure on atrial fibrillation that is published by the American Heart Association and a smartphone with the WebMD application. Participants are directed to use the WebMD application as often as they would like. |
Use of the WebMD app daily for 120 days.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of Days Covered
Time Frame: 12 months
|
Proportion of Days Covered (PDC) is obtained from electronic prescription and pharmacy fill data for oral anticoagulation.
PDC is calculated as a percentage (0 to 100%) accounting for days of prescription and date of fill.
PDC quantification accounts for days of hospitalization, switching to an alternative anticoagulant agent, and prescribing changes during 12-month follow-up.
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Self-reported adherence
Time Frame: 4, 8 and 12 months
|
A three-item instrument to ascertain self-reported non-adherence.
Items are scored with a Likert scale from 0 ("None fo the time.") to 5 ("Every time.").
The score is scaled as a continuous measure (0 to 15) and dichotomous categorization.
|
4, 8 and 12 months
|
Change from baseline Atrial Fibrillation Effect on QualiTy of life (AFEQT) at 4, 8 and 12 months
Time Frame: Baseline, 4, 8 and 12 months
|
The AFEQT is a widely used measure of atrial fibrillation-specific health-related quality of life.
Scores range from 0 to 100 with higher scores indicating superior health-related quality of life in AF.
The AFEQT measure consists of a global score and 4 domains (symptoms, daily activities, treatment concerns, and treatment satisfaction).
We prioritize the global score because of its specificity to AF, our experience with this measure in our preliminary and pilot studies, extensive validation, and ease of administration.
The AFEQT subdomains (symptoms, daily activities, treatment concerns, and treatment satisfaction) constitute secondary outcomes.
|
Baseline, 4, 8 and 12 months
|
Emergency room visits
Time Frame: 4, 8 and 12 months
|
The number of emergency room visits will be quantified at 4, 8 and 12 months.
These data will be used to compare health care utilization between the two study arms.
|
4, 8 and 12 months
|
Urgent care visits
Time Frame: 4, 8 and 12 months
|
The number of urgent care visits will be quantified at 4, 8 and 12 months.
These data will be used to compare health care utilization between the two study arms.
|
4, 8 and 12 months
|
Days of hospitalization
Time Frame: 4, 8 and 12 months
|
The number of days of hospitalization will be quantified at 4, 8 and 12 months.
These data will be used to compare health care utilization between the two study arms.
|
4, 8 and 12 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Jared W. Magnani, MD, MSc, University of Pittsburgh
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
January 8, 2020
Primary Completion (Actual)
May 27, 2023
Study Completion (Actual)
August 2, 2023
Study Registration Dates
First Submitted
August 28, 2019
First Submitted That Met QC Criteria
August 29, 2019
First Posted (Actual)
September 3, 2019
Study Record Updates
Last Update Posted (Actual)
November 30, 2023
Last Update Submitted That Met QC Criteria
November 27, 2023
Last Verified
November 1, 2023
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- STUDY19050386
- R01HL143010 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
YES
IPD Plan Description
The study team will share individual participant data that underlie the results reported in the study's central manuscripts after deidentification (text, tables, figures, and appendices).
IPD Sharing Time Frame
Such data will be available beginning 9 months and ending 36 months following publication of the main manuscripts resulting from this clinical trial.
IPD Sharing Access Criteria
Data will be made available to those investigators whose proposed use of the data has been approved by an independent review committee identified for this purpose.
Proposals may be submitted up to 36 months following article publication.
Applicants requesting access to the data will be responsible for the minimal administrative costs to provide the data set.
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
- ANALYTIC_CODE
- CSR
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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