Optimizing Hospital Resources: Reducing Unnecessary Visits for Elective Cardioversion in Atrial Tachyarrhythmia Patients by using a Mobile App

Background Atrial fibrillation (AF) is the most common and increasingly prevalent tachyarrhythmia, affecting millions of individuals worldwide. Rhythm control, including cardioversion, is favoured in AF patients to restore and maintain sinus rhythm (SR). In 70% of the patients with recent-onset AF, there is spontaneous conversion to SR. Consequently, a significant proportion of elective electrical cardioversion (ECV) procedures may be unnecessary, leading to avoidable hospital visits and wasted treatment slots. Purpose To determine whether a mobile application that measures heart rhythm before an elective ECV can reduce these unnecessary hospital visits. Methods In this single-centre retrospective study, we collected data from AF patients referred for an elective ECV in the OLVG, Amsterdam, the Netherlands. Eligible patients were encouraged to download a mobile that uses photoplethysmography (PPG) to check their heart rhythm. Inclusion criteria included age >18 years, persisting AF, and referral for an elective ECV. Patients were excluded if atrial tachycardia was present, patients did not have a mobile device, patients had a language barrier, or if a pacemaker or cardiac implantable defibrillator was present. All participants were asked to perform a PPG measurement 48 hours before their scheduled hospital admission. The app also explained the importance of anticoagulation adherence. The study focused on how many hospital visits could be avoided and the overall reduction in unnecessary visits thanks to the app. Results A total of 208 patients, scheduled for 247 ECVs, participated. The average age was 69 years ±9.1, 32% were female, and the average BMI was 28.0 kg/m² ±5.6. Of the patients, 52% had hypertension, 14% had diabetes, and 11% had a history of stroke or transient ischaemic attack. Out of 247 planned ECVs, 56 (22.7%) were cancelled. In 43 (76.8%) of these cases, the cancellation was due to spontaneous reversion to sinus rhythm. Other reasons included inadequate oral anticoagulant use (5.4%), electrolyte disturbances (1.9%), improper medication usage (1.9%), unknown causes (1.9%), and cancellation based on echocardiographic findings (1.9%). The mobile app detected sinus rhythm in 33 (58.9%) patients before the scheduled procedure. In 10 (17.8%) additional cases, sinus rhythm was confirmed via a twelve-lead ECG because either the PPG recording was undetermined (n = 1) or the app was not used as directed (n = 9). Conclusion The two main reasons for cancelling cardioversion were spontaneous return to sinus rhythm and poor adherence to anticoagulant therapy, which led to a loss of 19% of scheduled procedure slots. Notably, the mobile app identified sinus rhythm in nearly 60% of cancelled cases and 97% of those who used it correctly. Although 20% of the spontaneous converted patients did not use the mobile app, this study shows that the app could potentially optimize resource use by reducing unnecessary hospital visits by up to 13%.