Adherence to mobile health for intermittent rhythm monitoring to detect recurrences after emergency department visit for recent-onset atrial fibrillation: a subanalysis of the RACE 7 ACWAS trial
Authors: Van Der Velden RMJ , Pluymaekers NAHA , Dudink EAMP , Luermans JGLM , Meeder JG , Lenderink T , Widdershoven J , Bucx JJJ , Rienstra M , Van Gelder IC , Crijns HJGM , Linz D 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Netherlands Organization for Health Research and Development–Health Care Efficiency Research Program

Introduction
In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See (RACE 7 ACWAS) trial an early cardioversion approach was compared to a delayed cardioversion approach for patients with recent-onset symptomatic atrial fibrillation (AF), followed by a four-week monitoring period using mobile health (mHealth).

Purpose
To evaluate the adherence and motivation to a four-week mHealth prescription to daily intermittent rhythm monitoring for recurrences after emergency department visit in patients with recent-onset AF. In addition, we studied predictors of mHealth adherence and motivation and evaluated whether recurrences during this four-week period influenced adherence and motivation patterns.

Methods
After the index visit, patients were asked to use an electrocardiographic-based telemetric device to record one minute heart rate and rhythm recordings three times daily and in case of symptoms during a period of four weeks. For patients who collected recordings for more than four weeks, data was censored at four weeks. Adherence and patient motivation based on the number of monitoring days and full monitoring days were evaluated. A p-value of &lt;0.05 was considered statistically significant.

Results
335 patients (58% men; median age 67±11 years) used the telemetric device and were included in the current analysis. The median overall adherence of all patients was 83.3% (IQR 29.9%). The median number of monitoring days was 27 (5), whereas the median number of full monitoring days was 16 (14). Age and the index episode being a recurrent paroxysm of AF rather than a first presentation were identified as independent predictors of adherence (odds ratio (OR) 1.037 (95%CI 1.015-1.060), p=0.001 and OR 1.863 (95%CI 1.190-2.916), p=0.007, respectively). Age (OR 1.031 (95%CI 1.009-1.053), p=0.005) and the use of antiarrhythmic drugs (OR 1.800 (95%CI 1.047-3.093), p=0.033) were identified as independent predictors of motivation. Patients with recurrences had significantly higher median adherence (87.7% vs 81.5%, p=0.028) and more full monitoring days (18 (14) days vs 15 (13) days, p=0.024), and were more likely to perform additional recordings (78.8% vs 49.2%, p=&lt;0.001) compared to patients without recurrences.

Conclusion
Patients with recent-onset AF showed good adherence and motivation to a four-week mHealth prescription to monitor for AF recurrences after an emergency department visit for recent-onset AF. Adherence and motivation were high during the entire monitoring period, indicating that intermittent rhythm monitoring using mHealth is feasible for 1 month. Whether comparable mHealth adherence and motivation can be achieved in real world clinical scenarios outside a randomized study, warrants further observational studies.