Mobile health intervention improves detection of postoperative, de novo AF: The Box 2.0

A mobile health intervention consisting of BP, temperature, weight and ECG monitoring improved detection of postoperative and de novo atrial fibrillation following cardiac surgery compared with the usual care, researchers reported.

The results of The Box 2.0 study were published in EP Europace.

“This observational cohort study shows that follow-up with mHealth devices could increase [postoperative AF] detection in postcardiac surgery,” Tom E. Biersteker, MD, PhD candidate in the department of cardiology at Leiden University Medical Center in Leiden, The Netherlands, and colleagues wrote. “The effects on AF complications need to be addressed in further research. Also, this study observed a reduced number of unplanned ED visits in the intervention arm, although [a nurse practitioner] reviewed mHealth data twice weekly.”

In the original The Box randomized trial, researchers assigned 200 patients with either STEMI or non-ST-segment ACS to follow-up using a mobile health intervention for the improvement of BP control, or the usual care.

Researchers reported no significant difference in BP control between the two groups at 12 months, according to the study.

The present Box 2.0 study included 730 adult patients who underwent cardiac surgery at Leiden University Medical Center and assigned them either a mobile health intervention or the usual care to evaluate whether a mobile health intervention could improve detection of postoperative AF. Cardiac surgery was defined as any procedure requiring sternotomy.

Participants in the mobile health intervention group received a box containing an activity tracker, BP monitor, thermometer and a weight scale (all Withings products); a single-lead ECG monitor (Alivecor) and a 12-lead ECG monitor (CardioSecur).

Patients assigned to the mobile health intervention were on average younger, were less likely to smoke and had lower prevalence of diabetes compared with the usual care group. In addition, patients in the intervention arm had longer mean hospital stay, and a greater proportion were prescribed antiarrhythmic drugs at discharge compared with those in the usual care arm.

In the mobile health intervention arm, a total of 4,136 12-lead ECGs were collected.

Postoperative AF was detected in 16.7% of the intervention arm compared with 6.8% in the control group (adjusted RR = 2.15; 95% CI, 1.55-3.97).

In addition, de novo AF was detected in 6.5% of the mobile health intervention arm compared with 1.8% of the usual care group (aRR = 3.94; 95% CI, 1.5-11.27).

Moreover, participants in the intervention group experienced fewer unplanned ED visits compared with usual care (13.4% vs. 23.6%; OR = 0.5; 95% CI, 0.34-0.74; P = .0005).

“The Box was overall described as easy to use, and 89.9% of all Box participants found the prescribed measurement frequency to be appropriate,” the researchers wrote. “This difference is hypothesized to be caused by improved individualized care (‘patient tailoring’) and an increased insight The Box provided in the patient’s own health status, but may also be partly explained by The Box largely being a gift and by the fact that the intervention group received additional care.”

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