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Jiang J, Gu X, Cheng CD, Li HX, Sun XL, Duan RY, Zhu Y, Sun L, Chen FK, Bao ZY, Zhang Y, Shen JH. The Hospital-Community-Family-Based Telemedicine (HCFT-AF) Program for Integrative Management of Patients With Atrial Fibrillation: Pilot Feasibility Study. JMIR Mhealth Uhealth 2020; 8:e22137. [PMID: 33084588 PMCID: PMC7641782 DOI: 10.2196/22137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 12/30/2022] Open
Abstract
Background The potential effectiveness of integrated management in further improving the prognosis of patients with atrial fibrillation has been demonstrated; however, the best strategy for implementation remains to be discovered. Objective The aim of this study was to ascertain the feasibility of implementing integrated atrial fibrillation care via the Hospital-Community-Family–Based Telemedicine (HCFT-AF) program. Methods In this single-arm, pre-post design pilot study, a multidisciplinary teamwork, supported by efficient infrastructures, provided patients with integrated atrial fibrillation care following the Atrial fibrillation Better Care (ABC) pathway. Eligible patients were continuously recruited and followed up for at least 4 months. The patients’ drug adherence, and atrial fibrillation–relevant lifestyles and behaviors were assessed at baseline and at 4 months. The acceptability, feasibility, and usability of the HCFT-AF technology devices and engagement with the HCFT-AF program were assessed at 4 months. Results A total of 73 patients (mean age, 68.42 years; 52% male) were enrolled in November 2019 with a median follow up of 132 days (IQR 125–138 days). The patients’ drug adherence significantly improved after the 4-month intervention (P<.001). The vast majority (94%, 64/68) of indicated patients received anticoagulant therapy at 4 months, and none of them received antiplatelet therapy unless there was an additional indication. The atrial fibrillation–relevant lifestyles and behaviors ameliorated to varying degrees at the end of the study. In general, the majority of patients provided good feedback on the HCFT-AF intervention. More than three-quarters (76%, 54/71) of patients used the software or website more than once a week and accomplished clinic visits as scheduled. Conclusions The atrial fibrillation–integrated care model described in this study is associated with improved drug adherence, standardized therapy rate, and lifestyles of patients, which highlights the possibility to better deliver integrated atrial fibrillation management. Trial Registration Clinicaltrials.gov NCT04127799; https://clinicaltrials.gov/ct2/show/NCT04127799
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Affiliation(s)
| | - Xiang Gu
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Chen-Di Cheng
- Second Affiliated Hospital, Xiang-Ya Medical College of Central South University, Changsha, China
| | - Hong-Xiao Li
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xiao-Lin Sun
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | | | - Ye Zhu
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Lei Sun
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Fu-Kun Chen
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Zheng-Yu Bao
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Yi Zhang
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Jian-Hua Shen
- Medical College of Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, China
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Guo X, Gu X, Jiang J, Li H, Duan R, Zhang Y, Sun L, Bao Z, Shen J, Chen F. A Hospital-Community-Family-Based Telehealth Program for Patients With Chronic Heart Failure: Single-Arm, Prospective Feasibility Study. JMIR Mhealth Uhealth 2019; 7:e13229. [PMID: 31833835 PMCID: PMC6935047 DOI: 10.2196/13229] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 06/06/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
Background An increasing number of patients with chronic heart failure (CHF) are demanding more convenient and efficient modern health care systems, especially in remote areas away from central cities. Telehealth is receiving increasing attention, which may be useful to patients with CHF. Objective This study aimed to evaluate the feasibility of a hospital-community-family (HCF)–based telehealth program, which was designed to implement remote hierarchical management in patients with CHF. Methods This was a single-arm prospective study in which 70 patients with CHF participated in the HCF-based telehealth program for remote intervention for at least 4 months. The participants were recruited from the clinic and educated on the use of smart health tracking devices and mobile apps to collect and manually upload comprehensive data elements related to the risk of CHF self-care management. They were also instructed on how to use the remote platform and mobile app to send text messages, check notifications, and open video channels. The general practitioners viewed the index of each participant on the mobile app and provided primary care periodically, and cardiologists in the regional central hospital offered remote guidance, if necessary. The assessed outcomes included accomplishments of the program, usability and satisfaction, engagement with the intervention, and changes of heart failure–related health behaviors. Results As of February 2018, a total of 66 individuals, aged 40-79 years, completed the 4-month study. Throughout the study period, 294 electronic medical records were formed on the remote monitoring service platform. In addition, a total of 89 remote consultations and 196 remote ward rounds were conducted. Participants indicated that they were generally satisfied with the intervention for its ease of use and usefulness. More than 91% (21/23) of physicians believed the program was effective, and 87% (20/23) of physicians stated that their professional knowledge could always be refreshed and enhanced through a library hosted on the platform and remote consultation. More than 60% (40/66) of participants showed good adherence to the care plan in the study period, and 79% (52/66) of patients maintained a consistent pattern of reporting and viewing their data over the course of the 4-month follow-up period. The program showed a positive effect on self-management for patients (healthy diet: P=.046, more fruit and vegetable intake: P=.02, weight monitoring: P=.002, blood pressure: P<.001, correct time: P=.049, and daily dosages of medicine taken: P=.006). Conclusions The HCF-based telehealth program is feasible and provided researchers with evidence of remote hierarchical management for patients with CHF, which can enhance participants’ and their families’ access and motivation to engage in self-management. Further prospective studies with a larger sample size are necessary to confirm the program’s effectiveness.
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Affiliation(s)
- Xiaorong Guo
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Xiang Gu
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Jiang Jiang
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Hongxiao Li
- Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Ruoyu Duan
- Dalian Medical University, Dalian, Liaoning, China.,Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Yi Zhang
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Lei Sun
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Zhengyu Bao
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Jianhua Shen
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
| | - Fukun Chen
- Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China
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