The Hospital-Community-Family-Based Telemedicine (HCFT-AF) Program for Integrative Management of Patients With Atrial Fibrillation: Pilot Feasibility Study

Jiang Jiang, Xiang Gu, Chen-Di Cheng, Hong-Xiao Li, Xiao-Lin Sun, Ruo-Yu Duan, Ye Zhu, Lei Sun, Fu-Kun Chen, Zheng-Yu Bao, Yi Zhang, Jian-Hua Shen, Jiang Jiang, Xiang Gu, Chen-Di Cheng, Hong-Xiao Li, Xiao-Lin Sun, Ruo-Yu Duan, Ye Zhu, Lei Sun, Fu-Kun Chen, Zheng-Yu Bao, Yi Zhang, Jian-Hua Shen

Abstract

Background: The potential effectiveness of integrated management in further improving the prognosis of patients with atrial fibrillation has been demonstrated; however, the best strategy for implementation remains to be discovered.

Objective: The aim of this study was to ascertain the feasibility of implementing integrated atrial fibrillation care via the Hospital-Community-Family-Based Telemedicine (HCFT-AF) program.

Methods: In this single-arm, pre-post design pilot study, a multidisciplinary teamwork, supported by efficient infrastructures, provided patients with integrated atrial fibrillation care following the Atrial fibrillation Better Care (ABC) pathway. Eligible patients were continuously recruited and followed up for at least 4 months. The patients' drug adherence, and atrial fibrillation-relevant lifestyles and behaviors were assessed at baseline and at 4 months. The acceptability, feasibility, and usability of the HCFT-AF technology devices and engagement with the HCFT-AF program were assessed at 4 months.

Results: A total of 73 patients (mean age, 68.42 years; 52% male) were enrolled in November 2019 with a median follow up of 132 days (IQR 125-138 days). The patients' drug adherence significantly improved after the 4-month intervention (P<.001). The vast majority (94%, 64/68) of indicated patients received anticoagulant therapy at 4 months, and none of them received antiplatelet therapy unless there was an additional indication. The atrial fibrillation-relevant lifestyles and behaviors ameliorated to varying degrees at the end of the study. In general, the majority of patients provided good feedback on the HCFT-AF intervention. More than three-quarters (76%, 54/71) of patients used the software or website more than once a week and accomplished clinic visits as scheduled.

Conclusions: The atrial fibrillation-integrated care model described in this study is associated with improved drug adherence, standardized therapy rate, and lifestyles of patients, which highlights the possibility to better deliver integrated atrial fibrillation management.

Trial registration: Clinicaltrials.gov NCT04127799; https://ichgcp.net/clinical-trials-registry/NCT04127799.

Keywords: atrial fibrillation; feasibility study; integrative management; self-management; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Jiang Jiang, Xiang Gu, Chen-Di Cheng, Hong-Xiao Li, Xiao-Lin Sun, Ruo-Yu Duan, Ye Zhu, Lei Sun, Fu-Kun Chen, Zheng-Yu Bao, Yi Zhang, Jian-Hua Shen. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 21.10.2020.

Figures

Figure 1
Figure 1
Flow diagram of the pilot study.
Figure 2
Figure 2
Screenshots of the mobile app for patients.
Figure 3
Figure 3
The Hospital-Community-Family–based Telemedicine Program to implement integrated atrial fibrillation care.

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