title: Self-monitoring for atrial fibrillation recurrence in the discharge period post-cardiac surgery using an iPhone electrocardiogram.
abstract: OBJECTIVE
  Postoperative atrial fibrillation (POAF) occurs in 25-40% of patients following cardiac surgery, and is associated with a significant increased risk of stroke and mortality. Routine surveillance is not performed post-discharge; however, recurrence of POAF can occur in up to 30% of patients discharged in sinus rhythm. This study aimed to determine the feasibility of patients self-monitoring with an iPhone handheld electrocardiogram (iECG) to identify recurrence of POAF in the post-discharge period following cardiac surgery.
  
  
  METHODS
  Patients with POAF following cardiac surgery were eligible for participation if they had no prior history of atrial fibrillation (AF) and were discharged home in stable sinus rhythm. Participants were provided with an iECG and asked to record a 30-s iECG, four times per day for 4 weeks post-discharge. iECGs were automatically transmitted to a secure server, and reviewed for the presence of AF by the research team and a validated algorithm. All participants also received brief education on AF.
  
  
  RESULTS
  Forty-two participants completed the intervention (mean age 69 ± 9 years, 80% male). Self-monitoring for POAF recurrence using an iECG was feasible and acceptable, and participants felt empowered. Self-monitoring identified 24% (95% confidence interval, 12-39%) with an AF recurrence within 17 days of hospital discharge. These participants were significantly younger than those without AF recurrence (64 ± 7 vs 70 ± 10 years; P = 0.025), and had a significantly lower CHA2DS2-VASc score (2.3 ± 1.2 vs 3.7 ± 2.3; P = 0.007). However, 80% were at high enough stroke risk to warrant consideration of anticoagulation, i.e. CHA2DS2-VASc score ≥2. Only 30% of recurrences were associated with palpitations. Participation also improved AF knowledge from 6.4 ± 1.8 to 7.3 ± 1.8 (P = 0.02), of a total score of 10.
  
  
  CONCLUSIONS
  Providing patients with an iECG is a non-invasive, inexpensive, convenient and feasible way to monitor for AF recurrence in post-cardiac surgery patients. It also provides a mechanism to provide knowledge about the condition and also potentially reduce anxiety. The success of patients using this technology also has implications for extending the use of iECG self-monitoring to other patient groups such as those undergoing antiarrhythmic interventions for AF.
authors: Sydney Medical School, University of Sydney, Sydney, Australia Sydney Nursing School, University of Sydney, Sydney, Australia Vascular Biology, Anzac Research Institute, Sydney, Australia nicole.lowres@sydney.edu.au.
authors: Nicole
authors: N
authors: Lowres
authors: North Shore Cardiovascular Education Centre, Royal North Shore Hospital, Sydney, Australia.
authors: Georgina
authors: G
authors: Mulcahy
authors: Sydney Nursing School, University of Sydney, Sydney, Australia.
authors: Robyn
authors: R
authors: Gallagher
authors: Sydney Medical School, University of Sydney, Sydney, Australia Vascular Biology, Anzac Research Institute, Sydney, Australia Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia.
authors: Saul
authors: S
authors: Ben Freedman
authors: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia.
authors: David
authors: D
authors: Marshman
authors: North Shore Cardiovascular Education Centre, Royal North Shore Hospital, Sydney, Australia.
authors: Ann
authors: A
authors: Kirkness
authors: School of Public Health, University of Sydney, Sydney, Australia.
authors: Jessica
authors: J
authors: Orchard
authors: Sydney Nursing School, University of Sydney, Sydney, Australia.
authors: Lis
authors: L
authors: Neubeck
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D018670:Monitoring, Ambulatory / Q000295:instrumentation*; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D010351:Patient Discharge; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000517:prevention & control*; D055502:Secondary Prevention / Q000295:instrumentation; D012648:Self Care / Q000295:instrumentation*; D000068997:Smartphone; D020521:Stroke / Q000517:prevention & control; D019616:Thoracic Surgical Procedures
keywords: Atrial fibrillation; Cardiac surgery; Knowledge; Monitoring; Postoperative; Screening