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Telemedicine: the future of personalised atrial fibrillation care in a post pandemic world?
FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Public Institution(s). Main funding source(s): The pilot phase of the Virtual Ward was funded by Leicester, Leicestershire and Rutland Clinical Commissioning Group and supported by a Digital Healthcare Partnership Award from NHS Innovation (now Tran...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10206919/ http://dx.doi.org/10.1093/europace/euad122.556 |
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author | Kotb, A Armstrong, S Koev, I Antoun, I Vali, Z Barker, J Panchal, G Mavilakandy, A Chin, S H Lazdam, M Ibrahim, M Sandilands, A Somani, R Ng, G A |
author_facet | Kotb, A Armstrong, S Koev, I Antoun, I Vali, Z Barker, J Panchal, G Mavilakandy, A Chin, S H Lazdam, M Ibrahim, M Sandilands, A Somani, R Ng, G A |
author_sort | Kotb, A |
collection | PubMed |
description | FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Public Institution(s). Main funding source(s): The pilot phase of the Virtual Ward was funded by Leicester, Leicestershire and Rutland Clinical Commissioning Group and supported by a Digital Healthcare Partnership Award from NHS Innovation (now Transformation Directorate). BACKGROUND: The current model of care for patients with atrial fibrillation (AF) is born out of legacy physician-centred care models. The development and acceptance of digital technology have enabled the advent of novel telemedicine-based models for patients with fast AF. PURPOSE: A virtual AF ward was implemented as a proof-of-concept care model for patients with AF and rapid ventricular response. METHODS: Patients presenting acutely with AF or Atrial flutter (AFL) to the hospital were onboarded to the virtual ward and managed remotely at home, after being given access to a single-lead ECG device (Kardia), a blood pressure monitor and pulse oximeter with instructions to record daily ECGs, blood pressure, oxygen saturations and complete an online AF symptom questionnaire. Data were uploaded to a digital platform (Dignio) for daily review by the clinical team. Primary outcomes included admission avoidance, re-admission avoidance, and patient satisfaction. Patient satisfaction was assessed using the NHS Friends and Family test (FFT) in addition to narrative feedback. RESULTS: There were 50 admissions to the virtual ward between January and August 2022. Twenty-four initial hospital admissions were avoided with patients instead directly enrolled from the outpatient setting and a further 25 re-admissions were appropriately prevented during virtual surveillance, avoiding a total of 49 admissions to hospital beds. Most admissions were in AF 78% (n=39) or AFL 18% (n=9), with two admissions frequently alternating between sinus rhythm and AF 4% (n=2). Mean HR at the time of admission and discharge was 122 ± 26 and 82 ± 27 bpm, respectively. FFT response rate was 90% (n=45), with 100% positive responses. Only one patient declined using the service due to technology related anxiety. None of the patients demanded to unilaterally terminate the monitoring, or stopped using the online platform before being discharged from the virtual ward. CONCLUSION: This is a first real-world experience of an AF virtual ward that demonstrates a potential for reducing the healthcare burden imposed by AF admissions, while providing the holistic and personalised care that AF needs. Work is ongoing to further confirm safety and cost-effectiveness upon progress in a larger patient cohort. [Figure: see text] [Figure: see text] |
format | Online Article Text |
id | pubmed-10206919 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-102069192023-05-25 Telemedicine: the future of personalised atrial fibrillation care in a post pandemic world? Kotb, A Armstrong, S Koev, I Antoun, I Vali, Z Barker, J Panchal, G Mavilakandy, A Chin, S H Lazdam, M Ibrahim, M Sandilands, A Somani, R Ng, G A Europace 38.7 - Remote Patient Monitoring and Telehealth FUNDING ACKNOWLEDGEMENTS: Type of funding sources: Public Institution(s). Main funding source(s): The pilot phase of the Virtual Ward was funded by Leicester, Leicestershire and Rutland Clinical Commissioning Group and supported by a Digital Healthcare Partnership Award from NHS Innovation (now Transformation Directorate). BACKGROUND: The current model of care for patients with atrial fibrillation (AF) is born out of legacy physician-centred care models. The development and acceptance of digital technology have enabled the advent of novel telemedicine-based models for patients with fast AF. PURPOSE: A virtual AF ward was implemented as a proof-of-concept care model for patients with AF and rapid ventricular response. METHODS: Patients presenting acutely with AF or Atrial flutter (AFL) to the hospital were onboarded to the virtual ward and managed remotely at home, after being given access to a single-lead ECG device (Kardia), a blood pressure monitor and pulse oximeter with instructions to record daily ECGs, blood pressure, oxygen saturations and complete an online AF symptom questionnaire. Data were uploaded to a digital platform (Dignio) for daily review by the clinical team. Primary outcomes included admission avoidance, re-admission avoidance, and patient satisfaction. Patient satisfaction was assessed using the NHS Friends and Family test (FFT) in addition to narrative feedback. RESULTS: There were 50 admissions to the virtual ward between January and August 2022. Twenty-four initial hospital admissions were avoided with patients instead directly enrolled from the outpatient setting and a further 25 re-admissions were appropriately prevented during virtual surveillance, avoiding a total of 49 admissions to hospital beds. Most admissions were in AF 78% (n=39) or AFL 18% (n=9), with two admissions frequently alternating between sinus rhythm and AF 4% (n=2). Mean HR at the time of admission and discharge was 122 ± 26 and 82 ± 27 bpm, respectively. FFT response rate was 90% (n=45), with 100% positive responses. Only one patient declined using the service due to technology related anxiety. None of the patients demanded to unilaterally terminate the monitoring, or stopped using the online platform before being discharged from the virtual ward. CONCLUSION: This is a first real-world experience of an AF virtual ward that demonstrates a potential for reducing the healthcare burden imposed by AF admissions, while providing the holistic and personalised care that AF needs. Work is ongoing to further confirm safety and cost-effectiveness upon progress in a larger patient cohort. [Figure: see text] [Figure: see text] Oxford University Press 2023-05-24 /pmc/articles/PMC10206919/ http://dx.doi.org/10.1093/europace/euad122.556 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com |
spellingShingle | 38.7 - Remote Patient Monitoring and Telehealth Kotb, A Armstrong, S Koev, I Antoun, I Vali, Z Barker, J Panchal, G Mavilakandy, A Chin, S H Lazdam, M Ibrahim, M Sandilands, A Somani, R Ng, G A Telemedicine: the future of personalised atrial fibrillation care in a post pandemic world? |
title | Telemedicine: the future of personalised atrial fibrillation care in a post pandemic world? |
title_full | Telemedicine: the future of personalised atrial fibrillation care in a post pandemic world? |
title_fullStr | Telemedicine: the future of personalised atrial fibrillation care in a post pandemic world? |
title_full_unstemmed | Telemedicine: the future of personalised atrial fibrillation care in a post pandemic world? |
title_short | Telemedicine: the future of personalised atrial fibrillation care in a post pandemic world? |
title_sort | telemedicine: the future of personalised atrial fibrillation care in a post pandemic world? |
topic | 38.7 - Remote Patient Monitoring and Telehealth |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10206919/ http://dx.doi.org/10.1093/europace/euad122.556 |
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