SPC365

Digital patient tool for reporting quality of life after Atrial Fibrillation catheter ablation: outcomes from a Portuguese Healthcare Centre

Session: Comunicações Orais - Sessão 19 - Saúde Digital e Economia da Saúde
Speaker: Rafael Silva Teixeira

Congress: CPC 2023
Topic: N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
Theme: 33. e-Cardiology / Digital Health
Subtheme: 33.4 Digital Health
Session Type: Comunicações Orais
FP Number: ---
Authors: Rafael Silva Teixeira; Mariana S. Brandão; João Gonçalves Almeida; Paulo Fonseca; Cátia Isabel Costa; Ana Mosalina Manuel; Francisco Ramires; Madalena Plácido; Martim Sousa; Marco Oliveira; Helena Gonçalves; João Primo; Ricardo Fontes-Carvalho

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Introduction:</span></span></strong>&nbsp;<span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> Even though symptoms drive indication in AF ablation, they have not been consistently incorporated as standard primary outcomes in ablation trials.&nbsp;Only recently, attention has focused on the benefits of ablation on quality of life (QOL) associated with AF.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">&nbsp;</span></span></span><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Aim:</span></span></strong><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> To&nbsp;determine the magnitude and durability of clinical benefits provided by AF ablation.</span></span>&nbsp;</span></span></span><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">&nbsp;</span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Methods:</span></span></strong><strong>&nbsp;</strong><strong>&nbsp;</strong><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">We implemented a digital follow-up (FUP) program for patients (pts) with&nbsp;AF&nbsp;referred for ablation&nbsp;</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">in our high-volume </span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">centre</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> since&nbsp;December 2020. FUP included scheduled visits and remote monitoring through a new digital health platform allowing&nbsp;real-time&nbsp;interaction&nbsp;between&nbsp;patients and doctors.&nbsp;The primary outcome was QoL as measured by the AF Effect on QoL (AFEQT) summary score reported by pts&nbsp;using the digital patient-engagement tool. The primary outcome&nbsp;was&nbsp;analysed using a repeated-measures non-linear mixed model with&nbsp;random&nbsp;baseline score, time as fixed effects&nbsp;and month 12 response included as outcome variable.&nbsp;Subgroups analysis examined&nbsp;the effect of baseline AFEQT score on primary outcome.&nbsp;</span></span>&nbsp;</span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Results:</span></span></strong><strong>&nbsp;</strong><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">From the 305 ablations performed, 253 pts were enrolled until September</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">&nbsp;2022 (age 60&plusmn;11 years,&nbsp;33</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">%&nbsp;</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">female</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">, 78% paroxysmal). During FUP time (</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">mean</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> 11.9&plusmn;5.8 months), 1225 AFEQT&nbsp;questionnaires&nbsp;were collected from 222 different pts.&nbsp;Overall questionnaire completeness rate was 54.5%. Mean baseline AFEQT score was 64&plusmn;14 points and 80&plusmn;16 points at 12 months (absolute improvement of 18&plusmn;4 points, relative improvement of 33.2&plusmn;22.0%, p&lt;0.001). Absolute improvement in QoL varied as a function of baseline AFEQT score (p&lt;0.001). For patients with the lowest </span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">tertile</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> (score range 0-57) the mean improvement was 15.6&plusmn;14.6 points, the middle </span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">tertile</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> (score range 57-70) increased </span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">in</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> 17.6&plusmn;1.9 points and the highest </span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">tertile</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> had the highest absolute improvement (22.0&plusmn;2.3 points). Relative improvement was similar between subgroups (p=0.07). During FUP,&nbsp;AF recurred in&nbsp;</span></span><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">34 pts (14.5%), 14 of which during the first month of FUP (6%). &nbsp;Less than 7% of pts had at least one emergency department visit (n=16) and no deaths were reported.</span></span>&nbsp;</span></span></span></p>

<p style="text-align:start"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Conclusion:</span></span></strong><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">&nbsp;Among pts with symptomatic AF, ablation led to significant improvements in QoL at 12 months, independent of baseline levels.</span></span>&nbsp;</span></span></span></p>