Time investments and questions raised by atrial fibrillation patients following a personalized educational follow-up strategy
Authors: Knaepen L , Essarti H , Delesie M , Onder R , Vijgen J , Dendale P , Ector J , Desteghe L , Heidbuchel H 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) has a complex treatment strategy. As stated in the recent guidelines for AF management, AF management requires a holistic and multidisciplinary approach in which a personalized follow-up strategy is important to involve patients in their care. This also includes the need for an improved communication method in which patients can contact the healthcare team between in-hospital follow-up moments to easily ask questions with a low threshold.

Purpose
Two personalized follow-up methods for AF management (in-person and online) are currently being studied in a prospective, randomized controlled trial. The aim of this subanalysis is to evaluate time investment to answer patients' questions.

Methods
At three Belgian hospitals, a total of 1.038 AF patients were randomized to two groups with personalized education and follow-up, and a control group. The educational intervention focuses on four elements: improving patients' AF knowledge, improving OAC therapy adherence, encouraging self-care capabilities based on personal AF risk factors, and the reachability of an AF specialized team. Patients in the in-person group were followed personally at the hospital at regular time points, while the patients in the online group received education via an online platform. During the whole follow-up period, patients of both intervention groups could ask questions via e-mail or by phone contact.

Results
A total of 628 questions were raised by 275 patients (137 in-person and 138 online patients) with a mean number of 4.85±2.57 questions per patient. Patients in the online group had a trend towards asking more questions than the in-person group (2.46±2.08 vs. 2.11±1.74; p=0.061). However, there was no significant difference when looking at medical questions (online 2.12±1.80; in-person 2.16±2.42; p=0.55). In both groups, most questions were asked by phone contact (in-person: 72%; online: 51%; Fig. 1, red bars), although significantly less by the online group (p&lt;0.001). In the in-person group, most questions were related to their study visit appointments (27.3%), symptoms (23.9%) and medication (23.2%). In the online group, most questions were related to the online platform (38.9%), symptoms (16.5%) and medication (11.2%). The research team spent on average 7.37±8.18 minutes to answer a question. There was a significant difference in duration to answer questions of the specific categories (p&lt;0.001, Fig, 2). The top three categories on which the most time was spent were questions about symptoms (14.94±12.455 min), treatment and clinical investigations (9.29±7.9 min) and follow-up of clinical parameters (6.94±5.79 min).

Conclusion
A personalized educational follow-up method includes the possibility for patients to ask questions if needed. Most questions are related to AF symptoms and treatment. This indicates that a specialized AF team can be supportive in the management of AF patients.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The AF-EduCare study is a project supported by the Fund for Scientific Research, Flanders (T002917N).