Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Self-reported mobile health-based risk factor and CHA2DS2-VASc-score assessment in patients with atrial fibrillation: TeleCheck-AF results
K. Betz1, A.N.L. Hermans1, M. Gawalko1, H. A. K. Hillmann2, A. Sohaib3, R. Van der Velden1, D.V.M. Verhaert1, D. Scherr1, J. Meier4, A. Sultan5, D. Steven5, E. Terentieva5, R. Pisters6, M. Hemels6, L. Voorhout6, P. Lodzinski7, B. Krzowski7, D. Gupta8, N. Kozhuharov8, H. Gruwez9, K. Vernooy1, N. Pluymaekers1, J. M. Hendriks10, M. Manninger-Wünscher4, D. Duncker11, D. Linz1
1CARIM - School for Cardiovascular Sciences, Maastricht UMC+Heart+Vascular Center, Maastricht, NL; 2Institut für Pharmakologie, Universitätsklinikum Essen, Essen; 31st Floor, Hambledon Wing East, King´s College London, London, UK; 4Klinische Abteilung für Kardiologie, LKH-Univ. Klinikum Graz - Universitätsklinik für Innere Medizin, Graz, AT; 5Herzzentrum - Kardiologie, Universitätsklinikum Köln, Köln; 6Cardiology, Rijnstate Hospital, Arnhem, NL; 7Cardiology, Medical University of Warsaw, Warsaw, PL; 8Liverpool Heart and Chest Hospital, Liverpool, UK; 9Dept. of Cardiology, University Hospital Gasthuisberg, Leuven, BE; 10College of Nursing and Health Sciences, Caring Futures Institute, Adelaide, AU; 11Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover;

INTRODUCTION. THE TELECHECK-AF APPROACH IS AN ON-DEMAND MOBILE HEALTH (MHEALTH) INFRASTRUCTURE INCORPORATING MOBILE APP-BASED HEART RATE AND RHYTHM MONITORING THROUGH TELECONSULTATION. WE EVALUATED FEASIBILITY AND ACCURACY OF SELF-REPORTED MHEALTH-BASED AF RISK FACTORS AND CHA₂DS₂-VASC-SCORE IN ATRIAL FIBRILLATION (AF) PATIENTS MANAGED WITHIN THIS APPROACH. 

MATERIALS AND METHODS. CONSECUTIVE PATIENTS FROM EIGHT INTERNATIONAL TELECHECK-AF CENTERS WERE ASKED TO COMPLETE AN APP-BASED 10-ITEM QUESTIONNAIRE RELATED TO RISK FACTORS, ASSOCIATED CONDITIONS AND CHA2DS2-VASC-SCORE COMPONENTS. PATIENT’S MEDICAL HISTORY WAS RETRIEVED FROM ELECTRONIC HEALTH RECORDS (EHR).

RESULTS. AMONG 994 PATIENTS, 954 (96%) PATIENTS (38% FEMALE, MEDIAN AGE 65 YEARS) COMPLETED THE QUESTIONNAIRE AND WERE INCLUDED IN THIS ANALYSIS. THE ACCURACY OF SELF-REPORTED ASSESSMENT WAS HIGHEST FOR PACEMAKER AND ANTICOAGULATION TREATMENT AND LOWEST FOR HEART FAILURE AND ARRHYTHMIAS. PATIENTS WHO KNEW THAT AF INCREASES THE STROKE RISK, MORE OFTEN HAD A 100% OR ≥80% CORRELATION BETWEEN EHR- AND APP-BASED RESULTS COMPARED TO THOSE WHO DID NOT KNOW (27% VS 14% OR 84% VS 77%, P=0.001). THROMBOEMBOLIC EVENTS WERE MORE OFTEN REPORTED IN APP (VS EHR) IN ALL COUNTRIES, WHEREAS HIGHER SELF-REPORTED HYPERTENSION AND ANTICOAGULANT TREATMENT WERE OBSERVED IN GERMANY AND HEART FAILURE IN THE NETHERLANDS. IF THE APP-BASED QUESTIONNAIRE ALONE WAS USED FOR CLINICAL DECISION-MAKING ON ANTICOAGULATION INITIATION, 26% OF PATIENTS WOULD HAVE BEEN UNDERTREATED AND 6.1% - OVERTREATED.

CONCLUSION. SELF-REPORTED MHEALTH-BASED ASSESSMENT OF AF RISK FACTORS IS FEASIBLE. IT SHOWS HIGH ACCURACY OF PACEMAKER AND ANTICOAGULATION TREATMENT, NEVERTHELESS, DISPLAYS LIMITED ACCURACY FOR SOME OF THE CHA2DS2-VASC-SCORE COMPONENTS. DIRECT HEALTH CARE PROFESSIONAL ASSESSMENT OF RISK FACTORS REMAINS INDISPENSABLE TO ENSURE HIGH QUALITY CLINICAL-DECISION MAKING.

Table. Sensitivity and specificity of app-based with electronic health record-based results.

App-based question

Sensitivity

Specificity

Do you have a pacemaker?

0.958

0.983

Were you ever diagnosed with cardiac arrhythmias?

0.898

0.348

Are you (or were you before) diagnosed with or treated for atrial fibrillation or AF?

0.724

0.593

Are you (or were you before) treated for vascular disease in your legs or aorta? Or did you ever suffer from a heart attack?

0.403

0.787

Are you (or were you before) treated for heart failure or pulmonary edema?

0.551

0.943

Did you ever suffer from thrombosis or a stroke, with or without serious consequences (CVA or TIA)?

0.723

0.786

Are you (or were you before) treated for hypertension?

0.497

0.905

Are you (or were you before) treated for diabetes?

0.591

0.935

Do you take anticoagulants?

0.945

0.803

Legend: The heatmap scale reflects the highest agreement between app- and EHR-based results (green) and the lowest agreement (red).
https://dgk.org/kongress_programme/jt2022/aP858.html