Aim: To evaluate changes in healthcare utilization during the implementation of the TeleCheck-AF approach (teleconsultation supported by app-based heart rate/rhythm monitoring) in an atrial fibrillation (AF) outpatient clinic.

Methods and results: TeleCheck-AF is a digital care pathway, which consists of a structured teleconsultation (“Tele”) preceded by an app-based on-demand heart rate and rhythm monitoring infrastructure (“Check”) and the consecutive integration of the app-derived findings in a comprehensive AF management (“AF”), which was implemented in time of the global COVID-19 pandemic. Patients with AF, which were treated by a conventional approach in 2019 (standard care) and by the TeleCheck-AF approach in 2020 in the AF outpatient clinic of the Maastricht University Medical Center+ (MUMC+) were compared in this prospective case-crossover analysis. Healthcare utilization in terms of numbers and modes of outpatient contacts (teleconsultation vs face-to-face), number of emergency department (ED) presentations and use of diagnostic resources (i.e. ECG, Holter, echocardiography) as well as related reimbursement were analysed. A patient experience survey which encompassed five questions regarding use of the app and patient satisfaction with the remote heart rate and rhythm control was performed in patients within the TeleCheck-AF approach.

Ninety-one patients with AF (median age 68 years; 43% women) were analysed. Fifty-two percent had a history of previous electrical cardioversion and 66% of previous AF-ablation. Within the conventional approach, 113 face-to-face consultations and 1 teleconsultation were performed. After the implementation of TeleCheck-AF, the number of face-to-face consultations was reduced by 53% and teleconsultations increased by 5100%. While 151 ECGs and 42 Holter-ECGs were performed within the conventional approach, the number of ECGs reduced by 45% and Holter-ECG by 35% within the TeleCheck-AF approach. Emergency department presentations did not differ significantly in the conventional compared to TeleCheck-AF approach (22 vs 17). Patients’ satisfaction within the TeleCheck-AF approach was high. However, the change in healthcare utilization in TeleCheck-AF treated AF patients resulted in a mutation in declarable care products and a drop in reimbursement by health insurances.

Conclusion: The implementation of TeleCheck-AF was associated with a change in health care utilization, which resulted in a disproportional drop in reimbursement by health insurances due to a mutation in declarable care products. The result of this analysis was basis to design a new reimbursement code for the TeleCheck-AF approach in the Netherlands.

 

Fig.1: Graphical Abstract