The European TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: centre and patient experiences

Abstract

Aims: TeleCheck-AF is a multicentre international project initiated to maintain care delivery for patients with atrial fibrillation (AF) during COVID-19 through teleconsultations supported by an on-demand photoplethysmography-based heart rate and rhythm monitoring app (FibriCheck®). We describe the characteristics, inclusion rates, and experiences from participating centres according the TeleCheck-AF infrastructure as well as characteristics and experiences from recruited patients.

Methods and results: Three surveys exploring centre characteristics (n = 25), centre experiences (n = 23), and patient experiences (n = 826) were completed. Self-reported patient characteristics were obtained from the app. Most centres were academic (64%) and specialized public cardiology/district hospitals (36%). Majority of the centres had AF outpatient clinics (64%) and only 36% had AF ablation clinics. The time required to start patient inclusion and total number of included patients in the project was comparable for centres experienced (56%) or inexperienced in mHealth use. Within 28 weeks, 1930 AF patients were recruited, mainly for remote AF control (31% of patients) and AF ablation follow-up (42%). Average inclusion rate was highest during the lockdown restrictions and reached a steady state at a lower level after easing the restrictions (188 vs. 52 weekly recruited patients). Majority (>80%) of the centres reported no problems during the implementation of the TeleCheck-AF approach. Recruited patients [median age 64 (55-71), 62% male] agreed that the FibriCheck® app was easy to use (94%).

Conclusion: Despite different health care settings and mobile health experiences, the TeleCheck-AF approach could be set up within an extremely short time and easily used in different European centres during COVID-19.

Keywords: Atrial fibrillation; COVID-19; Remote monitoring; TeleCheck-AF; Telemedicine; eHealth; mHealth.

Figure 1

Number of recruited patients per clinical centre and European geographical location of centres. Inclusion rates apply to centres that included ten or more patients. Columns showed number of recruited patients; yellow line showed the real number of patients that started heart rhythm and rate monitoring (status from 9 October 2020).

Figure 2

Timeline from centre inclusion to first ten patients’ enrolment. Centres with previous experience with mHealth (yellow), dates of centre inclusion (blue), and days of patients’ enrolment (grey) are highlighted. The date of 26 March was chosen as start of the ‘first week’ as the first centre joined the project, beside Maastricht centre, and official date of TeleCheck-AF was announced at 4 April, therefore first week counts nine instead of seven days.

Figure 3

Weekly inclusion rate per country. *Weekly inclusion rate of the ‘first week’ was calculated for nine days instead of seven days. Inclusion rate was highest during the lockdown restrictions (n=829; 188 per week) lasting for 1st to 7th weeks and reached a steady state at a lower level after easing the restrictions (n=1101; 52 per week) lasting from 8th to 28th weeks (status from 9 October 2020). To simplify calculations, the border between the ‘lockdown’ and ‘easing the restrictions’ was chosen for the 7th week as it was the week in which the last country introduced the easing the restrictions. AT, Austria; BE, Belgium; DE, Germany; IE, Ireland; NL, The Netherlands; PL, Poland; PVI, pulmonary vein isolation; SE, Sweden.

Figure 4

Centre experiences (n = 23). AF, atrial fibrillation; PPG, photoplethysmography.

Figure 5

Patient experiences (n = 826).