Nicole Lowres1, Georgina Mulcahy2, Robyn Gallagher3, Saul Ben Freedman4, David Marshman5, Ann Kirkness2, Jessica Orchard6, Lis Neubeck3. 1. Sydney Medical School, University of Sydney, Sydney, Australia Sydney Nursing School, University of Sydney, Sydney, Australia Vascular Biology, Anzac Research Institute, Sydney, Australia nicole.lowres@sydney.edu.au. 2. North Shore Cardiovascular Education Centre, Royal North Shore Hospital, Sydney, Australia. 3. Sydney Nursing School, University of Sydney, Sydney, Australia. 4. Sydney Medical School, University of Sydney, Sydney, Australia Vascular Biology, Anzac Research Institute, Sydney, Australia Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia. 5. Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia. 6. School of Public Health, University of Sydney, Sydney, Australia.
Abstract
OBJECTIVES: Postoperative atrial fibrillation (POAF) occurs in 25-40% of patients following cardiac surgery, and is associated with a significant increased risk of stroke and mortality. Routine surveillance is not performed post-discharge; however, recurrence of POAF can occur in up to 30% of patients discharged in sinus rhythm. This study aimed to determine the feasibility of patients self-monitoring with an iPhone handheld electrocardiogram (iECG) to identify recurrence of POAF in the post-discharge period following cardiac surgery. METHODS: Patients with POAF following cardiac surgery were eligible for participation if they had no prior history of atrial fibrillation (AF) and were discharged home in stable sinus rhythm. Participants were provided with an iECG and asked to record a 30-s iECG, four times per day for 4 weeks post-discharge. iECGs were automatically transmitted to a secure server, and reviewed for the presence of AF by the research team and a validated algorithm. All participants also received brief education on AF. RESULTS: Forty-two participants completed the intervention (mean age 69 ± 9 years, 80% male). Self-monitoring for POAF recurrence using an iECG was feasible and acceptable, and participants felt empowered. Self-monitoring identified 24% (95% confidence interval, 12-39%) with an AF recurrence within 17 days of hospital discharge. These participants were significantly younger than those without AF recurrence (64 ± 7 vs 70 ± 10 years; P = 0.025), and had a significantly lower CHA2DS2-VASc score (2.3 ± 1.2 vs 3.7 ± 2.3; P = 0.007). However, 80% were at high enough stroke risk to warrant consideration of anticoagulation, i.e. CHA2DS2-VASc score ≥2. Only 30% of recurrences were associated with palpitations. Participation also improved AF knowledge from 6.4 ± 1.8 to 7.3 ± 1.8 (P = 0.02), of a total score of 10. CONCLUSIONS: Providing patients with an iECG is a non-invasive, inexpensive, convenient and feasible way to monitor for AF recurrence in post-cardiac surgery patients. It also provides a mechanism to provide knowledge about the condition and also potentially reduce anxiety. The success of patients using this technology also has implications for extending the use of iECG self-monitoring to other patient groups such as those undergoing antiarrhythmic interventions for AF.
OBJECTIVES:Postoperative atrial fibrillation (POAF) occurs in 25-40% of patients following cardiac surgery, and is associated with a significant increased risk of stroke and mortality. Routine surveillance is not performed post-discharge; however, recurrence of POAF can occur in up to 30% of patients discharged in sinus rhythm. This study aimed to determine the feasibility of patients self-monitoring with an iPhone handheld electrocardiogram (iECG) to identify recurrence of POAF in the post-discharge period following cardiac surgery. METHODS:Patients with POAF following cardiac surgery were eligible for participation if they had no prior history of atrial fibrillation (AF) and were discharged home in stable sinus rhythm. Participants were provided with an iECG and asked to record a 30-s iECG, four times per day for 4 weeks post-discharge. iECGs were automatically transmitted to a secure server, and reviewed for the presence of AF by the research team and a validated algorithm. All participants also received brief education on AF. RESULTS: Forty-two participants completed the intervention (mean age 69 ± 9 years, 80% male). Self-monitoring for POAF recurrence using an iECG was feasible and acceptable, and participants felt empowered. Self-monitoring identified 24% (95% confidence interval, 12-39%) with an AF recurrence within 17 days of hospital discharge. These participants were significantly younger than those without AF recurrence (64 ± 7 vs 70 ± 10 years; P = 0.025), and had a significantly lower CHA2DS2-VASc score (2.3 ± 1.2 vs 3.7 ± 2.3; P = 0.007). However, 80% were at high enough stroke risk to warrant consideration of anticoagulation, i.e. CHA2DS2-VASc score ≥2. Only 30% of recurrences were associated with palpitations. Participation also improved AF knowledge from 6.4 ± 1.8 to 7.3 ± 1.8 (P = 0.02), of a total score of 10. CONCLUSIONS: Providing patients with an iECG is a non-invasive, inexpensive, convenient and feasible way to monitor for AF recurrence in post-cardiac surgery patients. It also provides a mechanism to provide knowledge about the condition and also potentially reduce anxiety. The success of patients using this technology also has implications for extending the use of iECG self-monitoring to other patient groups such as those undergoing antiarrhythmic interventions for AF.
Authors: Nicole Lowres; Graham S Hillis; Marc A Gladman; Mark Kol; Jim Rogers; Vincent Chow; Ferris Touma; Cara Barnes; Joanne Auston; Ben Freedman Journal: Int J Cardiol Heart Vasc Date: 2020-06-29
Authors: Jelle C L Himmelreich; Evert P M Karregat; Wim A M Lucassen; Henk C P M van Weert; Joris R de Groot; M Louis Handoko; Robin Nijveldt; Ralf E Harskamp Journal: Ann Fam Med Date: 2019-09 Impact factor: 5.166
Authors: Kathleen T Hickey; Angelo B Biviano; Hasan Garan; Robert R Sciacca; Teresa Riga; Kate Warren; Ashton P Frulla; Nicole R Hauser; Daniel Y Wang; William Whang Journal: J Atr Fibrillation Date: 2017-02-28
Authors: Tom E Biersteker; Mark J Boogers; Robert Af de Lind van Wijngaarden; Rolf Hh Groenwold; Serge A Trines; Anouk P van Alem; Charles Jhj Kirchhof; Nicolette van Hof; Robert Jm Klautz; Martin J Schalij; Roderick W Treskes Journal: JMIR Res Protoc Date: 2020-04-21