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

Alok Kapoor, Anna Hayes, Jay Patel, Harshal Patel, Andreza Andrade, Kathleen Mazor, Carl Possidente, Kimberly Nolen, Rozelle Hegeman-Dingle, David McManus, Alok Kapoor, Anna Hayes, Jay Patel, Harshal Patel, Andreza Andrade, Kathleen Mazor, Carl Possidente, Kimberly Nolen, Rozelle Hegeman-Dingle, David McManus

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://ichgcp.net/clinical-trials-registry/NCT04118270.

International registered report identifier (irrid): RR2-21986.

Keywords: anticoagulation; anticoagulation risk; anticoagulation therapy; atrial fibrillation; atrial flutter; mobile health; mobile phone; shared decision-making; stroke risk.

Conflict of interest statement

Conflicts of Interest: AK received sponsored research support from Pfizer Inc for this project and has received similar support in the past from both Bristol-Myers Squibb and Pfizer Inc. DM received sponsored research support from Bristol Myers Squibb, Boehringer Ingelheim, Pfizer Inc, Biotronik, Philips Healthcare, and Flexcon and has consulted for Bristol-Myers Squibb, FlexCon, Samsung, Philips, Fitbit, and Pfizer Inc. AH, JP, HP, AA, DM, KM, and AK are employees of the Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, which received financial support from Pfizer Inc in connection with this research. CP, KN, and RHD are full-time employees of Pfizer Inc.

©Alok Kapoor, Anna Hayes, Jay Patel, Harshal Patel, Andreza Andrade, Kathleen Mazor, Carl Possidente, Kimberly Nolen, Rozelle Hegeman-Dingle, David McManus. Originally published in JMIR Cardio (https://cardio.jmir.org), 19.11.2021.

References

    1. Atrial filbrillation. Centers for Disease Control and Prevention. [2021-10-29]. .
    1. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013 Oct 15;112(8):1142–7. doi: 10.1016/j.amjcard.2013.05.063.S0002-9149(13)01288-5
    1. Kapoor A, Amroze A, Golden J, Crawford S, O'Day K, Elhag R, Nagy A, Lubitz SA, Saczynski JS, Mathew J, McManus DD. SUPPORT-AF: piloting a multi-faceted, electronic medical record-based intervention to improve prescription of anticoagulation. J Am Heart Assoc. 2018 Sep 04;7(17):e009946. doi: 10.1161/JAHA.118.009946.
    1. Miyasaka Y, Barnes ME, Bailey KR, Cha SS, Gersh BJ, Seward JB, Tsang TS. Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J Am Coll Cardiol. 2007 Mar 06;49(9):986–92. doi: 10.1016/j.jacc.2006.10.062. S0735-1097(06)03025-7
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després J-P, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB, American Heart Association Statistics CommitteeStroke Statistics Subcommittee Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015 Jan 27;131(4):e29–322. doi: 10.1161/CIR.0000000000000152.CIR.0000000000000152
    1. Cullen MW, Kim S, Piccini JP, Ansell JE, Fonarow GC, Hylek EM, Singer DE, Mahaffey KW, Kowey PR, Thomas L, Go AS, Lopes RD, Chang P, Peterson ED, Gersh BJ, ORBIT-AF Investigators Risks and benefits of anticoagulation in atrial fibrillation: insights from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry. Circ Cardiovasc Qual Outcomes. 2013 Jul;6(4):461–9. doi: 10.1161/CIRCOUTCOMES.113.000127.CIRCOUTCOMES.113.000127
    1. Gladstone DJ, Bui E, Fang J, Laupacis A, Lindsay MP, Tu JV, Silver FL, Kapral MK. Potentially preventable strokes in high-risk patients with atrial fibrillation who are not adequately anticoagulated. Stroke. 2009 Jan;40(1):235–40. doi: 10.1161/STROKEAHA.108.516344.STROKEAHA.108.516344
    1. Marzec LN, Wang J, Shah ND, Chan PS, Ting HH, Gosch KL, Hsu JC, Maddox TM. Influence of direct oral anticoagulants on rates of oral anticoagulation for atrial fibrillation. J Am Coll Cardiol. 2017 May 23;69(20):2475–84. doi: 10.1016/j.jacc.2017.03.540. S0735-1097(17)36716-5
    1. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland Jr JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW, American College of Cardiology/American Heart Association Task Force on Practice Guidelines 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014 Dec 02;64(21):e1–76. doi: 10.1016/j.jacc.2014.03.022. S0735-1097(14)01740-9
    1. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons. J Am Coll Cardiol. 2019 Jul 09;74(1):104–32. doi: 10.1016/j.jacc.2019.01.011. S0735-1097(19)30209-8
    1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener H-C, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016 Nov;18(11):1609–78. doi: 10.1093/europace/euw295.euw295
    1. AFib 2gether. Pfizer Inc. 2021. [2021-10-26]. .
    1. Kapoor A, Andrade A, Hayes A, Mazor K, Possidente C, Nolen K, Hegeman-Dingle R, McManus D. Usability, perceived usefulness, and shared decision-making features of the AFib 2gether mobile app: protocol for a single-arm intervention study. JMIR Res Protoc. 2021 Mar 24;10(2):e21986. doi: 10.2196/21986. v10i2e21986
    1. Stoyanov SR, Hides L, Kavanagh DJ, Zelenko O, Tjondronegoro D, Mani M. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR Mhealth Uhealth. 2015 Mar 11;3(1):e27. doi: 10.2196/mhealth.3422. v3i1e27
    1. Elwyn G, Hutchings H, Edwards A, Rapport F, Wensing M, Cheung W-Y, Grol R. The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks. Health Expect. 2005 Mar;8(1):34–42. doi: 10.1111/j.1369-7625.2004.00311.x. doi: 10.1111/j.1369-7625.2004.00311.x.HEX311
    1. Kapoor A, Amroze A, Vakil F, Crawford S, Der J, Mathew J, Alper E, Yogaratnam D, Javed S, Elhag R, Lin A, Narayanan S, Bartlett D, Nagy A, Shagoury BK, Fischer MA, Mazor KM, Saczynski JS, Ashburner JM, Lopes R, McManus DD. SUPPORT-AF II: supporting use of anticoagulants through provider profiling of oral anticoagulant therapy for atrial fibrillation: a cluster-randomized study of electronic profiling and messaging combined with academic detailing for providers making decisions about anticoagulation in patients with atrial fibrillation. Circ Cardiovasc Qual Outcomes. 2020 Feb;13(2):e005871. doi: 10.1161/CIRCOUTCOMES.119.005871.
    1. Terhorst Y, Philippi P, Sander LB, Schultchen D, Paganini S, Bardus M, Santo K, Knitza J, Machado GC, Schoeppe S, Bauereiß N, Portenhauser A, Domhardt M, Walter B, Krusche M, Baumeister H, Messner E-M. Validation of the Mobile Application Rating Scale (MARS) PLoS One. 2020;15(11):e0241480. doi: 10.1371/journal.pone.0241480. PONE-D-20-14930
    1. Elwyn G, Edwards A, Wensing M, Hood K, Atwell C, Grol R. Shared decision making: developing the OPTION scale for measuring patient involvement. Qual Saf Health Care. 2003 Apr;12(2):93–9. doi: 10.1136/qhc.12.2.93.
    1. Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995 Mar 13;155(5):469–73.
    1. Man-Son-Hing M, Laupacis A, O'Connor AM, Biggs J, Drake E, Yetisir E, Hart RG. A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: a randomized controlled trial. JAMA. 1999 Aug 25;282(8):737–43. doi: 10.1001/jama.282.8.737.joc90151
    1. Kunneman M, Branda ME, Hargraves IG, Sivly AL, Lee AT, Gorr H, Burnett B, Suzuki T, Jackson EA, Hess E, Linzer M, Brand-McCarthy SR, Brito JP, Noseworthy PA, Montori VM, Shared Decision Making for Atrial Fibrillation (SDM4AFib) Trial Investigators Assessment of shared decision-making for stroke prevention in patients with atrial fibrillation: a randomized clinical trial. JAMA Intern Med. 2020 Sep 01;180(9):1215–24. doi: 10.1001/jamainternmed.2020.2908. 2770473
    1. Jamaladin H, van de Belt TH, Luijpers LC, de Graaff FR, Bredie SJ, Roeleveld N, van Gelder MM. Mobile apps for blood pressure monitoring: systematic search in app stores and content analysis. JMIR Mhealth Uhealth. 2018 Nov 14;6(11):e187. doi: 10.2196/mhealth.9888. v6i11e187

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