A mobile health intervention improves detection of postoperative, novel AF: The Box 2.0

August 19, 2022

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The authors report no relevant financial disclosures.

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A mobile health intervention consisting of blood pressure, temperature, weight and EKG monitoring improved detection of postoperative and new atrial fibrillation after heart surgery compared with usual care, researchers report.

The results of The Box 2.0 study were published in EP Europe.

Atrial fibrillation 2019
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“This observational cohort study shows that follow-up with mHealth devices can be increased [postoperative AF] detection in post-cardiac surgery,” Tom E. BirsteckerMD, a postdoctoral fellow in the Department of Cardiology at Leiden University Medical Center in Leiden, the Netherlands, and colleagues write. “Effects on AF complications need to be addressed in further research.” Also, this study observed a reduced number of unscheduled ED visits in the intervention arm [a nurse practitioner] review mHealth data twice a week.”

In the original randomized trial, The Box, researchers assigned 200 patients with STEMI or non-ST-segment ACS to follow-up using a mobile health intervention to improve BP control or usual care.

The researchers reported no significant difference in BP control between the two groups at 12 months, according to the study.

The current Box 2.0 study included 730 adult patients who underwent cardiac surgery at the Leiden University Medical Center and were assigned to either a mobile health intervention or usual care to assess whether a mobile health intervention could improve the detection of postoperative AF. Cardiac surgery was defined as any procedure requiring a sternotomy.

Participants in the mobile health intervention group received a box containing an activity tracker, BP monitor, thermometer, and scale (all Withings products); single-channel ECG monitor (Alivecor) and 12-channel ECG monitor (CardioSecur).

Patients assigned to the mobile health intervention were on average younger, less likely to smoke, and had a lower prevalence of diabetes than the usual care group. In addition, patients in the intervention group had a longer average hospital stay and a greater proportion were prescribed antiarrhythmic drugs at discharge than those in the usual care group.

A total of 4136 12-lead ECGs were collected in the mobile health intervention arm.

Postoperative AF was detected in 16.7% of the intervention arm compared with 6.8% in the control arm (adjusted RR = 2.15; 95% CI, 1.55-3.97).

In addition, de novo AF was detected in 6.5% of the mobile health intervention group compared with 1.8% of the usual care group (aRR = 3.94; 95% CI, 1.5-11.27) .

Moreover, participants in the intervention group had fewer unplanned ED visits compared with usual care (13.4% vs. 23.6%; OR = 0.5; 95% CI, 0.34-0.74; P = 0.0005).

“The box was generally described as easy to use, and 89.9% of all box participants found the prescribed measurement frequency appropriate,” the researchers wrote. “This difference is thought to be caused by improved individualized care (‘patient tailoring’) and greater insight that the Box provides into the patient’s own health status, but may also be partially explained by the fact that the Box to it is also largely a gift of the fact that the intervention group received additional care.’


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