The Danish Future Patient Telerehabilitation Program for Patients With Atrial Fibrillation: Design and Pilot Study in Collaboration With Patients and Their Spouses

Birthe Dinesen, Josefine Dam Gade, Cathrine Skov Schacksen, Helle Spindler, Andi Eie Albertsen, Lars Dittmann, Mads Jochumsen, Dorthe Svenstrup Møller, Birthe Dinesen, Josefine Dam Gade, Cathrine Skov Schacksen, Helle Spindler, Andi Eie Albertsen, Lars Dittmann, Mads Jochumsen, Dorthe Svenstrup Møller

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules.

Objective: The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF.

Methods: This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients' perspectives. Secondary outcomes were the development of patients' knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0.

Results: Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups.

Conclusions: Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient-TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial.

Trial registration: ClinicalTrials.gov NCT04493437; https://ichgcp.net/clinical-trials-registry/NCT04493437.

Keywords: atrial fibrillation; cardiac rehabilitation; patient education; telerehabilitation.

Conflict of interest statement

Conflicts of Interest: None declared.

©Birthe Dinesen, Josefine Dam Gade, Cathrine Skov Schacksen, Helle Spindler, Andi Eie Albertsen, Lars Dittmann, Mads Jochumsen, Dorthe Svenstrup Møller. Originally published in JMIR Cardio (https://cardio.jmir.org), 19.07.2021.

Figures

Figure 1
Figure 1
Telerehabilitation in two phases.
Figure 2
Figure 2
Screen captures of selected information pages from the HeartPortal (Danish: Hjerteportalen.dk). (A) My page (Danish: Min side) with the latest measurement and access to dialogue and video consultation; (B) information module with information about what is AF? (Danish: Hvad er atrieflimren?); (C) overview of steps taken; and (D) overview of heart rhythm from the electrocardiography monitor.
Figure 3
Figure 3
Consolidated Standards of Reporting Trials (CONSORT) diagram of the pilot study.

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