Improving care for patients with atrial fibrillation through the use of a personal electrocardiogram

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia affecting more than six million people in the United States. The economic burden is estimated to be >$6 billion annually with catastrophic events dramatically increasing expenditure. When patients experience symptoms, they commonly present to an acute care facility; this can be costly and anxiety provoking. LOCAL PROBLEM: Same-day access issues prohibit patients from communicating directly with their cardiology provider, forcing them to use resources and increasing psychological burden. METHODS: A convenience sample, made up of 43 patients, was given a KardiaMobile device. Eligible patients had ≥2 AF-related emergency department (ED) or urgent care (UC) visits over 12 months, needed rate control with medication titration, or were monitored for AF reoccurrence after reestablishing sinus rhythm. INTERVENTIONS: Patients emailed recordings daily and when experiencing symptoms. The recordings were reviewed by a nurse practitioner (NP); abnormal readings were followed by a phone call, telehealth, or in-person visit. RESULTS: An independently designed survey was conducted online; almost all respondents (97%) found value in the project and the device. Virtually all respondents (97%) felt that the program improved access. A majority (86%) reported decreased anxiety. Had the respondents not been in the program, 34% indicated that they would have presented to an ED and 25% would have presented to an UC, realizing a cost savings of $81,950 in reduced ED visits alone. CONCLUSION: A personal electrocardiogram, with NP oversight, to manage AF is cost-effective and reduces unnecessary resource utilization. It is patient centered, improves access, and empowers patients to manage their symptoms.