Coordinating Healthcare with Artificial Intelligence-supported Technology in Atrial Fibrillation: CHAT-AF

The aim of the intervention is to support atrial fibrillation (AF) self-management and care coordination with artificial intelligence (AI)-supported technology. The intervention consists of a technology platform that enables the programming of a complex algorithm of automated voice calls (interactive voice response (IVR) technology) and text-message (SMS) and/or email, as well as includes an educational website. OUTREACHES The intervention will consist of a total of seven patient outreaches, delivered over the course of 6 months. The outreaches will occur at the following timepoints: 24-48 hours, 14 days, 1-, 2-, 3-, 4-, 5- months post-discharge from the hospital. All these outreaches will be automated and follow a complex algorithm. The format of each outreach consists of: 1. Automated phone call (IVR): The first point of contact in each outreach is via an automated and pre-recorded (real) voice phone call with interactive voice response technology (IVR) capabilities. Using IVR, patients can interact with a structured series of recorded messages and respond to queries using their voice (e.g. by saying “Yes”, “No” over the phone). Based on their responses to these queries, patients will receive recorded messages tailored to their individual needs. 2. SMS or email: If the patient cannot be reached via phone after three attempts, an SMS/email will be sent containing a link to a secure webpage. This webpage will have all the content addressed in the IVR call, in a written format, with options for patient’s to self-report using multiple choice answers. Each outreach will have specific goals and will vary slightly in the information delivered and querying items. Through these outreaches we are able to collect self-reported patient information, for example, does the patient have a regular GP/medical centre, have they booked/attended their GP appointment, do they have transportation barriers to accessing appointments, along with assessment of overall health status, AF symptoms and their impact on daily life, medication confidence and adherence. During these outreaches, we will also provide information on stroke, sleep apnoea, weight management, AF medical procedures and how to reduce alcohol intake. Patients will also receive health tips that can be incorporated into daily activities, these will comprise of broad and specific AF themes, which include, tips on maintaining a healthy lifestyle, ways to improve medication adherence, avoiding caffeine and energy drinks, reducing salt intake, healthy eating, exercise and managing AF. MANAGING ALERTS Based on patient responses to the questions asked in the outreaches, certain answers will trigger an alert, these include; poor overall health status (options ranging from; ‘excellent’ to ‘poor’, where ‘poor’ triggers an alert), impact of AF symptoms on daily life (options ranging from; ‘not at all’ to ‘extremely’, where ‘extremely’ triggers an alert), medication confidence is 1 or 2 out of a scale of 7 (where 1 is ‘not confident at all’ and 7 is ‘very confident’), non-adherence to medication, and not having booked or attended a GP appointment within 1 month of hospital discharge. These alerts will be sent directly to the Westmead Research team and escalated to clinicians or other members of the research team, as appropriate. These alerts will be addressed by calling the patient within 24-72 hours and triaging for priority. EDUCATION WEBSITE In addition to the outreaches, patients will have access to an education website, which will be tailored to each individual (based on whether or not they are smokers, drink alcohol, have hypertension, are on warfarin medication). The information will be organized into modules, these include; general AF information, AF procedures, medications, alcohol, blood pressure, smoking, weight management and general resources. Content will be in the form of links to online resources, videos and webpages (e.g. Heart Foundation, NPS). Majority of the content on the education website is readily available online on websites of reputable sources, such as The Heart Foundation Australia, NPS and HealthDirect. However, the website also contains a video series about atrial fibrillation that was developed by cardiologists from Westmead Hospital for their patients and not for the specific purpose of this research study. We will send out weekly emails/SMS (depending on their communication preference) containing a link to their personalised website to encourage patients to visit. We will not specify the frequency or duration of site usage, but will be able to record site access during the study for each participant. PROGRAM ENGAGEMENT STATISTICS Program engagement statistics will be collected using web analytics and system engagement metrics (e.g. number of successful phone calls, number of completed phone calls, comprehensiveness of data collected during IVR calls, number of visits on online education webpage and completion of education modules). We will also be able to determine the completion status of each outreach [querying items (e.g. overall health status, AF symptoms, impact on daily life, GP access, medication confidence and adherence) and knowledge assessment (stroke, sleep apnoea, weight management, AF medical procedures and how to reduce alcohol intake]. This will assist in determining the aspects of the program that were most engaging and those that participants found less appealing.