Guhl Emily, Althouse Andrew D, Pusateri Alexandra M, Kimani Everlyne, Paasche-Orlow Michael K, Bickmore Timothy W, Magnani Jared W
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
JMIR Cardio. 2020 Sep 4;4(1):e17162. doi: 10.2196/17162.
Atrial fibrillation (AF) is a common arrhythmia that adversely affects health-related quality of life (HRQoL). We conducted a pilot trial of individuals with AF using a smartphone to provide a relational agent as well as rhythm monitoring. We employed our pilot to measure acceptability and adherence and to assess its effectiveness in improving HRQoL and adherence.
This study aims to measure acceptability and adherence and to assess its effectiveness to improve HRQoL and adherence.
Participants were recruited from ambulatory clinics and randomized to a 30-day intervention or usual care. We collected baseline characteristics and conducted baseline and 30-day assessments of HRQoL using the Atrial Fibrillation Effect on Quality of Life (AFEQT) measure and self-reported adherence to anticoagulation. The intervention consisted of a smartphone-based relational agent, which simulates face-to-face counseling and delivered content on AF education, adherence, and symptom monitoring with prompted rhythm monitoring. We compared differences in AFEQT and adherence at 30 days, adjusted for baseline values. We quantified participants' use and acceptability of the intervention.
A total of 120 participants were recruited and randomized (59 to control and 61 to intervention) to the pilot trial (mean age 72.1 years, SD 9.10; 62/120, 51.7% women). The control group had a 95% follow-up, and the intervention group had a 93% follow-up. The intervention group demonstrated significantly higher improvement in total AFEQT scores (adjusted mean difference 4.5; 95% CI 0.6-8.3; P=.03) and in daily activity (adjusted mean difference 7.1; 95% CI 1.8-12.4; P=.009) compared with the control between baseline and 30 days. The intervention group showed significantly improved self-reported adherence to anticoagulation therapy at 30 days (intervention 3.5%; control 23.2%; adjusted difference 16.6%; 95% CI 2.8%-30.4%; P<.001). Qualitative assessments of acceptability identified that participants found the relational agent useful, informative, and trustworthy.
Individuals randomized to a 30-day smartphone intervention with a relational agent and rhythm monitoring showed significant improvement in HRQoL and adherence. Participants had favorable acceptability of the intervention with both objective use and qualitative assessments of acceptability.
心房颤动（AF）是一种常见的心律失常，会对健康相关生活质量（HRQoL）产生不利影响。我们对心房颤动患者进行了一项试点试验，使用智能手机提供关系代理以及心律监测。我们利用该试点来衡量可接受性和依从性，并评估其在改善HRQoL和依从性方面的有效性。
本研究旨在衡量可接受性和依从性，并评估其改善HRQoL和依从性的有效性。
参与者从门诊诊所招募，并随机分为30天的干预组或常规治疗组。我们收集了基线特征，并使用心房颤动对生活质量的影响（AFEQT）量表以及自我报告的抗凝依从性对HRQoL进行了基线和30天评估。干预措施包括一个基于智能手机的关系代理，它模拟面对面咨询，并提供有关房颤教育、依从性和症状监测的内容，并提示进行心律监测。我们比较了30天时AFEQT和依从性的差异，并对基线值进行了调整。我们量化了参与者对干预措施的使用情况和可接受性。
总共招募了120名参与者并将其随机分组（59名进入对照组，61名进入干预组）进行试点试验（平均年龄72.1岁，标准差9.10；62/120，51.7%为女性）。对照组的随访率为95%，干预组的随访率为93%。与对照组相比，干预组在基线和30天之间的AFEQT总分（调整后平均差异4.5；95%CI 0.6 - 8.3；P = 0.03）和日常活动（调整后平均差异7.1；95%CI 1.8 - 12.4；P = 0.009）方面有显著更高的改善。干预组在30天时自我报告的抗凝治疗依从性有显著改善（干预组3.5%；对照组23.2%；调整后差异16.6%；95%CI 2.8% - 30.4%；P < 0.001）。对可接受性的定性评估表明，参与者认为关系代理有用、信息丰富且值得信赖。
随机接受为期30天的带有关系代理和心律监测的智能手机干预的个体，在HRQoL和依从性方面有显著改善。参与者对干预措施的客观使用和可接受性的定性评估都有良好的接受度。
