JMIR Publications

ABSTRACT

Background:

Atrial fibrillation (AF) is a significant risk factor for stroke, especially in aging societies. Anticoagulation therapy is used to prevent stroke and, the efficacy and safety profiles of novel oral anticoagulants (NOACs) are comparable with those of vitamin-K antagonists (VKAs). Although NOACs do not require regular monitoring of anticoagulatory effects, there are concerns that they tend to be less long-lasting and have poorer adherence among patients than VKAs. A new application (the “Smart AF app”) was developed as a tool to improve adherence to oral anticoagulant medication in elderly individuals with AF.

Objective:

The aim of the present study was to evaluate the utility of the Smart AF app in individuals with AF.

Methods:

Patients with AF were enrolled at Kyoto Prefectural University of Medicine hospitals between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient applications at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool.

Results:

A total of 136 patients with AF were enrolled in this study. During the follow-up period, 111 patients underwent follow-up at 1 month, 109 at 3 months, and 96 at 6 months. The mean age of the enrolled patients was 64.3 years, and males accounted for 79.4% of the study population. The mean CHADS2 score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 and 10 patients were taking oral NOACs and oral warfarin, respectively. At baseline, mean adherence measured according to the MMAS-8 was 6.14 (SD 1.52), and 6.87 (SD 1.30) at 1 month, 6.69 (SD 1.53) at 3 months, and 6.98 (SD 1.34) at 6 months, demonstrating a significant increase at all time points compared with enrollment (all P<.01). The overall improvement in medication adherence with the intervention was attributed to an improvement of 77.8% in the high-grade group to a high level and 45.3% in the medium-grade group to a high level, and 72% in the low-grade group to a medium or high level.

Conclusions:

The Smart AF app improved medication adherence, even among elderly patients in whom AF is prevalent. In medication administration, an approach that emphasizes education using mobile health technology, simple reminder function, and patient engagement, may be helpful.