Prevention of depression in patients with atrial fibrillation using an online intervention, the HOPE-AF feasibility study

Abstract Introduction Atrial fibrillation (AF) is the most common cardiac arrhythmia with a lifetime estimated incidence of one in three. AF can cause severe burdens on the patient, both in terms of physical symptoms like palpitations and fatigue, but also in terms of psychological issues like reduced quality of life, anxiety and depression. Depression in cardiac patients is associated with poor health outcomes and increased societal costs, therefore there is a need to develop interventions to prevent depression. Purpose We examined the feasibility of a psychological personalized online intervention, aiming to prevent depression in patients with AF. Methods The study was conducted using a pre-post study design and mixed-methods approach. The HOPE-AF intervention was developed in collaboration with patients using a participatory design. The intervention was personalized and consisted of 4-12 modules, all including psychological tasks. Modules were assigned based on the individual risk profile of the patient, patient preferences and therapist assessment. The intervention was guided by a personal therapist, communicating through text messages, video and phone calls and provided on a secure platform. Therapists were psychologists or psychology students who were trained in cardiac psychology and delivering the intervention. We included 28 patients diagnosed with AF from 3 university hospitals. The primary feasibility outcome was drop-out, with a drop-out of 25% being considered acceptable. We used descriptive analyses to determine changes in the pre- and post-test questionnaires with a 3-month follow-up. The Hospital Anxiety and Depression Scale was used for assessment of anxiety and depression while the Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) was used for AF specific domains. Qualitative methods consisted of thematic analyses of semi-structured interviews with 10 patients. Results The drop-out rate was 7% (2/28). The mean change in depression score was -0.5 (standard deviation (SD): 1.3) and the mean change in anxiety score was -1.3 (SD: 2.7). AFEQT showed a mean change of 17.2 (14.6) for the global score, 15.0 (16.9) for symptoms, 19.3 (19.1) for daily activities, and 15.9 (17.0) for treatment concern, respectively. The qualitative analysis identified four themes: meaningful content, communication, technicalities, and personal gain. Overall, the patients found the intervention meaningful and felt safe due to cardiac-specific competencies among therapists. Patients felt engaged in the planning of their intervention and were satisfied with choice of video- or phone consultations. Patients found it easy to navigate on the intervention platform. Receiving psychological tools was perceived useful. Conclusion Our study showed that the research design and HOPE-AF intervention were feasible and acceptable and support progression to a fully powered randomized controlled trial to determine clinical effectiveness of the HOPE-AF intervention.