How simple ideas forged in the fire of adversity can change healthcare: telehealth for atrial fibrillation during the COVID 19 pandemic

Simple ideas imagined in the furnace of adversity can fundamentally alter our society and day-to-day life. Take for example, the invention of George Crum who in 1853 was working as a chef in the Moon Lake Lodge resort in Saratoga Springs, New York. A menu favourite at this resort was their French-fried potatoes. The potatoes were cut lengthwise, fried, and salted. George became increasing frustrated after a customer sent back the potatoes because they were too thick and soggy. Somewhat irritated and bothered by the complaint, the chef cut ultra-thin slices of the potatoes, fried, and salted them, much to the delight of the customer. These Saratago-chips became an international phenomenon and are now recognized as potato chips. We have been immersed in 2020 in a tremendous state of adversity as the COVID 19 pandemic has had effects far and wide. Hospitals, health systems, and countries refocused their efforts on preventing and managing the mass spread of disease throughout their populations. However, this left patients with chronic diseases at a significant disadvantage. First, people with chronic diseases were considered high risk and were instructed to remain isolated and removed from their routine social and personal obligations. This meant routine doctor’s visits for said chronic diseases were reduced to a trickle. Furthermore, many important and necessary tests are performed at follow-up visits that were no longer being routinely acquired. Patient status and health became increasingly difficult. Within healthcare systems and practices, a mad dash to pivot towards telemedicine was undertaken, especially for non-life-threatening chronic disease management like atrial fibrillation (AF). Atrial fibrillation is the most common sustained clinical cardiac arrhythmia and has been associated with significant morbidity and mortality if not recognized, controlled, and treated properly. Patients with AF were profoundly impacted during the pandemic as they are commonly considered high risk because of their age and other cardiovascular comorbidities. Gawalko et al. have implemented and evaluated the effectivenessof the TeleCheck-AF system, which integrates with previous mHealthsystems used in a variety of health practices. The authors should be commended for taking on such an ambitious task. They enrolled and surveyed both healthcare providers and patients from 25 centres across nine countries with a mix of academic and specialized public cardiology or district hospitals. The TeleCheck-AF system is a previously established 7-day system to assess patient cardiac function using a mobile phone app with or without other minimal electrocardiogram (ECG) equipment that was designed from rapid and broad implementation. Patients are instructed to record heart function three times per day and any time they feel additional symptoms. Patients are asked a questionnaire each time they complete the measurement and are reminded if measurements are not performed on time. Following the 7-day period, patients and providers met through video conferencing to discuss the results and modify therapy as needed. The goal of this study was to assess the success, usability, and patient and provider satisfaction with the TeleCheck-AF system. When they surveyed site principal contacts, they found that most sites thought the system was easy to use, easy to install, and interpretable. Major concerns for long-term implementation were integration into the electronic medical record (EMR), cost of the system, and data management. We found these results striking, in that a complicated system that tracks and updates centres based on AF, etc. could be implemented and perceived as simple to use while simultaneously generating useful clinical data. However, we would note that these surveys were administered to the central site coordinator, not to individual health providers. It would have been helpful to understand how unique and individual providers from diverse backgrounds perceived the usefulness and ease of use, as this type of input would help refine subsequent versions of the tool and its implementation. A primary concern of integrating these systems into the EMR is always a challenge, especially in the context of remote monitoring, as systems brace to receive an increasing amount of virtual and remote data. Each monitoring company seems to have a different format,