Physical activity, patient-reported symptoms, and clinical events: Insights into postprocedural recovery from personal digital devices

Victoria L Bartlett, Joseph S Ross, Nilay D Shah, Laura Ciaccio, Joseph G Akar, Peter A Noseworthy, Sanket S Dhruva, Victoria L Bartlett, Joseph S Ross, Nilay D Shah, Laura Ciaccio, Joseph G Akar, Peter A Noseworthy, Sanket S Dhruva

Abstract

Background: Personal digital devices may offer insights into patient recovery and an approach for remote monitoring after procedures.

Objective: To examine associations between activity measured using personal digital devices, patient-reported outcome measures (PROMs), and clinical events among patients after catheter ablation for atrial fibrillation (AF) or bariatric surgery.

Methods: We aggregated personal digital device, PROM, and electronic health record data in a study conducted at 2 health systems. We used Fitbit devices for step count assessments, KardiaMobile for cardiac rhythm assessments, and PROMs for pain and palpitations over 5 weeks.

Results: Among 59 patients, 30 underwent AF ablation and 29 bariatric surgery. Thirty-six patients (63%) reported pain. There was no difference in median [interquartile range] daily steps between patients with and those without pain (4419 [3286-7041] vs 3498 [2609-5888]; P = .23). Among AF ablation patients, 21 (70%) reported palpitations. Median daily steps were lower among those with palpitations than among those without (4668 [3021-6116] vs 8040 [6853-10,394]; P = .03). When accounting for within-subject correlation, recordings of AF were associated with a significant mean decrease in median daily steps (-351; 95% confidence interval -524 to -177; P <.01). Patients who received a new antiarrhythmic drug prescription had AF recorded in a median of 5 [5-5] of 5 total weeks, whereas patients who did not receive a new antiarrhythmic recorded AF in a median of 1 [0-3] week (P = .02).

Conclusion: Personal digital device and PROM data can provide insight into postprocedural recovery outside of usual clinical settings and may inform follow-up and clinical decision-making. (ClinicalTrials.gov Identifier: NCT03436082).

Keywords: Ablation; Activity; Atrial fibrillation; Bariatric surgery; Digital health; Patient-reported outcomes; Postprocedural recovery; Remote monitoring; Wearable devices.

Figures

Figure 1
Figure 1
Average predicted median daily step count for patients during weeks with and without pain. CI = confidence interval.
Figure 2
Figure 2
Average predicted median daily step count for weeks with and without palpitations. CI = confidence interval.
Figure 3
Figure 3
Marginal effect of an atrial fibrillation episode recorded on a mobile electrocardiographic device on median daily step count. CI = confidence interval.

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