Dirkjan Kauw1, Maarten A C Koole2, Michiel M Winter3, Daan A J Dohmen4, Igor I Tulevski5, Sebastiaan Blok6, G Aernout Somsen5, Marlies P Schijven7, Joris W J Vriend8, Daniëlle Robbers-Visser9, Barbara J M Mulder9, Berto J Bouma9, Mark J Schuuring10. 1. Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands. 2. Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cardiology Centers of the Netherlands, Amsterdam, the Netherlands; Department of Cardiology, Rode Kruis Ziekenhuis, Beverwijk, the Netherlands. 3. Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cardiology Centers of the Netherlands, Amsterdam, the Netherlands. 4. Luscii, Amsterdam, the Netherlands. 5. Cardiology Centers of the Netherlands, Amsterdam, the Netherlands. 6. Cardiology Centers of the Netherlands, Amsterdam, the Netherlands; Department of Vascular medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 7. Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 8. Department of Cardiology, Haga Teaching Hospital, the Hague, the Netherlands. 9. Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands. 10. Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Haga Teaching Hospital, the Hague, the Netherlands. Electronic address: m.j.schuuring@amsterdamumc.nl.
Abstract
BACKGROUND: Adults with congenital heart disease (ACHD) often suffer from deterioration related to cardiac arrhythmias, hypertension (HT) or heart failure (HF), frequently occurring between planned visits. Mobile health (mHealth) could improve management through remote monitoring by enabling swift therapeutic response and detecting new diagnoses. METHODS: We performed a prospective study employing mHealth in ACHD patients, weekly monitoring heart rhythm, weight and blood pressure. In case of consecutive threshold exceeding measurements or in case of new diagnosis, patients were contacted and if needed the treating physician was consulted. Inclusion criteria were: palpitations within the last three years (with or without arrhythmia diagnosis) or HF NYHA class ≥ II. We evaluated the detection of recurrences and new diagnosis of arrhythmias, HT and HF, adherence and patient experience (Net Promotor Score (NPS)). RESULTS: In total, 109 of the 268 invited ACHD patients were enrolled, 80 with palpitations, 13 with HF, 16 experienced both, mean age 45 (±13) years, 33% male. Median follow-up was 12 (Q1-Q3;9-14) months, 91 patients initiated all measurements (heart rhythm, weight and blood pressure). In 25% of the patients with diagnosed arrhythmias (14/56) recurrences of arrhythmias were detected; 13% of the patients with undiagnosed palpitations (4/32) were diagnosed with novel arrhythmias. In 38% of the patients with HT at baseline (6/16), treatment adjustment was necessary, 4% of the patients without HT (4/76) received novel HT diagnosis. Diuretics were adjusted in 7% of the patients with HF (2/29). Adherence was > 70% in 77% of the patients that started weekly measurements (70/91). Patients that were female, older of age and experienced palpitations at inclusion were more likely to acquire an adherence of > 70%. NPS was completed by 68 patients, 57 patients (84%) were promotors or neutral, and 11 patients (16%) were critics. CONCLUSIONS: mHealth offers advantages in the management of selected ACHD patients; it enabled early detection of recurrences and new diagnosis of arrhythmias, hypertension and heart failure, which lead to swift therapeutic response or remote reassurance. Furthermore, mHealth was well accepted with high adherence and positive patient experience.
BACKGROUND: Adults with congenital heart disease (ACHD) often suffer from deterioration related to cardiac arrhythmias, hypertension (HT) or heart failure (HF), frequently occurring between planned visits. Mobile health (mHealth) could improve management through remote monitoring by enabling swift therapeutic response and detecting new diagnoses. METHODS: We performed a prospective study employing mHealth in ACHD patients, weekly monitoring heart rhythm, weight and blood pressure. In case of consecutive threshold exceeding measurements or in case of new diagnosis, patients were contacted and if needed the treating physician was consulted. Inclusion criteria were: palpitations within the last three years (with or without arrhythmia diagnosis) or HF NYHA class ≥ II. We evaluated the detection of recurrences and new diagnosis of arrhythmias, HT and HF, adherence and patient experience (Net Promotor Score (NPS)). RESULTS: In total, 109 of the 268 invited ACHD patients were enrolled, 80 with palpitations, 13 with HF, 16 experienced both, mean age 45 (±13) years, 33% male. Median follow-up was 12 (Q1-Q3;9-14) months, 91 patients initiated all measurements (heart rhythm, weight and blood pressure). In 25% of the patients with diagnosed arrhythmias (14/56) recurrences of arrhythmias were detected; 13% of the patients with undiagnosed palpitations (4/32) were diagnosed with novel arrhythmias. In 38% of the patients with HT at baseline (6/16), treatment adjustment was necessary, 4% of the patients without HT (4/76) received novel HT diagnosis. Diuretics were adjusted in 7% of the patients with HF (2/29). Adherence was > 70% in 77% of the patients that started weekly measurements (70/91). Patients that were female, older of age and experienced palpitations at inclusion were more likely to acquire an adherence of > 70%. NPS was completed by 68 patients, 57 patients (84%) were promotors or neutral, and 11 patients (16%) were critics. CONCLUSIONS: mHealth offers advantages in the management of selected ACHD patients; it enabled early detection of recurrences and new diagnosis of arrhythmias, hypertension and heart failure, which lead to swift therapeutic response or remote reassurance. Furthermore, mHealth was well accepted with high adherence and positive patient experience.
Authors: Dirkjan Kauw; Dounya Schoormans; Gertjan Tj Sieswerda; Joost P Van Melle; Hubert W Vliegen; Arie P J Van Dijk; Mariët S Hulsbergen-Zwarts; Marco C Post; Tieneke J Ansink; Barbara J M Mulder; Berto J Bouma; Mark J Schuuring Journal: J Cardiovasc Nurs Date: 2022 Mar-Apr 01 Impact factor: 2.083
Authors: Anneloek Rauwerdink; Marise J Kasteleyn; Niels H Chavannes; Marlies P Schijven Journal: J Med Internet Res Date: 2021-11-25 Impact factor: 5.428