Self-Reported Mobile Health-Based Risk Factor and CHA 2 DS 2 -VASc-Score Assessment in Patients With Atrial Fibrillation: TeleCheck-AF Results.

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 CHA ₂ DS ₂ -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 CHA ₂ DS ₂ -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 CHA ₂ DS ₂ -VASc-score components. Direct health care professional assessment of risk factors remains indispensable to ensure high quality clinical-decision making.
Competing Interests: DSc has received speaker honoraria and/or travel grants from Bayer, Biosense Webster, Biotronik, BMS/Pfizer, Boehringer Ingelheim, Boston Scientific, Daiichi Sankyo, Medtronic, Zoll Medical, as well as research grants from Biosense Webster, Boston Scientific, and Zoll Medical. KV consultancy agreement with Boston, Medtronic, Biosense Webtster, Philips, and Abbott, Received educational grants from Medtronic, Abbott and Biosense Webster. JH declares that Flinders University has received speaker honoraria on his behalf from Biotronik. MM has received speaker honoraria and/or travel grants from Abbott, AOP Orphan, Bayer, Biotronik, Boston Scientific, Daiichi Sankyo, Pfizer, Zoll. DD has received speaker honoraria and/or travel grants from Abbott, Astra Zeneca, Bayer, Biotronik, Boehringer Ingelheim, Boston Scientific, Medtronic, Pfizer, Zoll. NK has received research grants from the Swiss National Science Foundation P400PM-194477, Gottfried und Julia Bangerter-Rhyner-Stiftung. The author acknowledges funding received from the European Society of Cardiology in form of an ESC Training Grant. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Hermans, Gawałko, Hillmann, Sohaib, van der Velden, Betz, Verhaert, Scherr, Meier, Sultan, Steven, Terentieva, Pisters, Hemels, Voorhout, Lodziński, Krzowski, Gupta, Kozhuharov, Gruwez, Vernooy, Pluymaekers, Hendriks, Manninger, Duncker and Linz.)