Atrial fibrillation self-management with an app: Good to go in SG?

A novel mobile application to help patients self-manage atrial fibrillation (AF) has been found useful and acceptable for Asians, according to a Singapore study.

Named the Self-management and Educational technology support Tool for AF patients (SETAF), the app was designed to complement future integrated AF care services in Singapore via patient education, monitoring, and self-management. SETAF is paired with a blood pressure and heart rate monitor that automatically uploads all measurements into a cloud database, enabling both patients and their care team to view the history and trends.

Through SETAF, patients can perform self-management triage assessments. An algorithm provides an actionable feedback based on the severity of symptoms such as palpitations, chest pain, and shortness of breath. Depending on their status, patients can be directed to call the hotline for medical advice (low risk) or to seek help immediately by calling an ambulance (emergent cases). 

Aside from self-assessment, SETAF also sends motivational messages and health-related surveys and provides access to educational videos and patient information sheets.

Functional, easy to use

The usability and acceptability of SETAF were tested in 37 AF patients (mean age 65.1 years, 29 men, 30 Chinese) recruited from an outpatient cardiology clinic in Singapore. All patients used the tool for 6 weeks, and 19 patients agreed to be interviewed.

Overall, the patients found SETAF to be an acceptable tool for the self-management of AF. They were happy with the tool’s educational and self-monitoring functions, which the patients said had helped them gain more understanding about their disease, stay motivated, and boost their confidence. [PLoS One 2022;17:e0262033]

The patients also felt reassured that their health data can be accessed remotely by their healthcare providers, expressing relief at the knowledge that they’re being monitored. Also, the patients noted that having a direct helpline to connect with their healthcare providers during symptomatic episodes could prevent unnecessary hospital admissions.

Overall, the perceived usefulness was reflected in the high usage of SETAF, with all patients reporting that they used the tool for at least 4–5 days a week. They also stated that the app was easy to use due to its guided tutorial and user-friendly interface.

Application usage data revealed that patients were more likely to interact with AF-related content, while interaction with the motivational message component of SETAF decreased over time. More than half of the patients said they would continue using SETAF and were willing to pay for it.

Finally, the patients put forward suggestions to improve the acceptance of SETAF, including better personalization of content, the need for psychosocial support feature, and reduction of language barriers.

“Acceptance of SETAF relied on its potential to fill the gaps in current AF care while being easy and convenient for patients to use,” according to the investigators.

“These findings support the acceptance of mobile health (mHealth) technology among the majority of our AF patients and their insights can inform the design of future mHealth interventions for them. For those patients who were unwilling to use SETAF in the future, an improved version of SETAF could potentially change their opinion,” they added.