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

• Published in: Frontiers in cardiovascular medicine 2021, Vol.8, p.757587
• Main Authors: Hermans, Astrid N L, Gawałko, Monika, Hillmann, Henrike A K, Sohaib, Afzal, van der Velden, Rachel M J, Betz, Konstanze, Verhaert, Dominique, Scherr, Daniel, Meier, Julia, Sultan, Arian, Steven, Daniel, Terentieva, Elena, Pisters, Ron, Hemels, Martin, Voorhout, Leonard, Lodziński, Piotr, Krzowski, Bartosz, Gupta, Dhiraj, Kozhuharov, Nikola, Gruwez, Henri, Vernooy, Kevin, Pluymaekers, Nikki A H A, Hendriks, Jeroen M, Manninger, Martin, Duncker, David, Linz, Dominik
• Format: Article
• Language: English
• ISSN: 2297-055X; 2297-055X

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 DS -VASc-score in atrial fibrillation (AF) patients managed within this approach. 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 DS -VASc-score components. Patient's medical history was retrieved from electronic health records (EHR). 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%, = 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. 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 DS -VASc-score components. Direct health care professional assessment of risk factors remains indispensable to ensure high quality clinical-decision making.