Mobile Electrocardiogram Monitoring and Health-Related Quality of Life in Patients With Atrial Fibrillation: Findings From the iPhone Helping Evaluate Atrial Fibrillation Rhythm Through Technology (iHEART) Study.
Billy A Caceres, Kathleen T Hickey, Suzanne B Bakken and 7 others
PMID 32015256WHAT IT FOUND
Adding smartphone ECG monitoring and atrial fibrillation lifestyle text messages to usual care did not improve quality of life or symptom severity over six months more than usual care alone.
Both groups improved during follow-up.
Key findings
01At six month follow-up, no significant differences were found between the intervention and control groups for any measure assessed.
02Global AF-specific quality-of-life scores increased by 18.5 points in the intervention group and 11.2 points in the control group, and AF symptom severity scores decreased by 5.4 and 4.5 points, respectively.
03In the 110 participants with complete data for quality-adjusted life-year analysis, there was no difference between groups from baseline to six months (p = 0.24).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The trial was done at one New York City site, and 77% of participants were male and 76% White, so it may not represent women or racially and ethnically diverse patients. The study was not powered to detect differences in AF-specific quality of life, generic quality of life, or symptom severity; it needed 300 participants for the QALY outcome but analysed 238. There was significant missing follow-up data, and quality of life and symptoms were measured only at baseline and six months, so shorter-term changes or longer-term effects could be missed. Participants with cognitive impairment or unwillingness to use technology, collect data, or receive text messages were excluded, so results may not apply to patients who cannot or will not use a smartphone. The intervention combined smartphone ECG monitoring with AF and lifestyle text messages, so the trial cannot show which component, if any, affected outcomes. Sixty-five percent of control participants had had a cardioversion, more than in the intervention group (p < 0.05), a baseline imbalance that could influence outcomes.
Declared interests
The authors declared no conflicts of interest. The paper identifies support from NIH grant R01NR014853.
The easy way to misread this
Do not read the null result as proof that smartphone ECG monitoring and text messages do not help. The study was not powered for quality of life or symptom severity, had missing data, and tested monitoring plus messages together, so it cannot rule out a benefit of either component.