Effectiveness of the AF-EduCare and AF-EduApp approach to improve atrial fibrillation knowledge and risk factor awareness in patients with atrial fibrillation: a randomized controlled trial.

Aims: Developing an integrated care pathway for atrial fibrillation (AF) patients is of pivotal importance, given the different treatment strategies. Moreover, knowledge about the condition is an important factor in engaging patients in their care. Patient education formed the core of the integrated AF-EduCare/AF-EduApp approach. The main aim of this manuscript is to report the impact of this approach on AF and risk factor (RF)-related knowledge and self-care awareness.

Methods and results: Atrial fibrillation patients (n = 1232) were randomized to standard care (SC) or three educational interventions: in-person, online, or app-based education. Patients in the intervention groups received targeted education based on their responses to the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) and a Self-Care Questionnaire (SCQ) presented at different time points. Patients who received educational follow-up reached a significantly higher knowledge score (in-person: 86.5 ± 13.2%; online: 82.5 ± 19.3%; app: 80.1 ± 15.0%) than the SC group (65.3 ± 16.6%) after 12/18 months (P < 0.001). The knowledge rapidly improved with the first sessions (i.e. 3 months) and remained sustained in all education groups. Patients with RF at baseline showed a slight but significant increase in awareness about their RF through education [e.g. no knowledge of last measured systolic blood pressure compared between education vs. SC: odds ratio of 0.45 (P = 0.012)], a change that was not seen in SC patients. Nevertheless, patients keep under-estimating the presence of their own RFs compared with objective documentation in their medical record (e.g. hypertension).

Conclusion: The JAKQ and SCQ are good instruments to provide targeted education to AF patients in daily clinical care. Knowledge level increases clinically significantly, but the impact on awareness about personal risk factors remains unsatisfactory.

Registration: ClinicalTrials/gov: NCT03707873NCT03788044.