Conversational HeAlth supporT in Atrial Fibrillation Self-Management (CHAT-AF-S)

The “CHAT-AF-S” intervention was co-designed by the investigator team, clinicians, patient engagement academic experts, behavioural scientists, consumers, and leverages results from previous CHAT-AF pilot (Australian New Zealand Clinical Trials Registry ACTRN12621000174886). The intervention consists of automated voice calls (with conversational artificial intelligence (AI) technology, including voice recognition and natural language understanding to evaluate participants’ verbal responses), accompanied by educational text messages. The goal of the intervention is to support and monitor patients with atrial fibrillation (AF) by encouraging medication adherence, risk factor reduction and disease self-management by providing educational content related to AF. This program aims to also identify patients that might be at higher risk of having AF complications (e.g., have poor overall health, unsure if on blood thinner medications, are highly symptomatic and unable to manage their symptoms) by alerting the central clinical management team. OUTREACHES The intervention will consist of a total of six patient outreaches, delivered over the course of 3 months. The outreaches will occur at the following timepoints: 24 – 48 hours, 15 days, 30 days, 45 days, 60 days, and 75 days post-discharge from hospital services. All these outreaches will be automated following an algorithm. The format of each outreach consists of: 1. Automated phone calls (conversational AI): The first point of contact is via an automated call. If participants are not reached in the first call attempt, the technology will call again in the next 24 hours (3 call attempts). During the automated phone call, patients can 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 information tailored to their individual needs (i.e., information on blood thinning medications, rhythm control medications, blood pressure control, General Practitioner visits, AF action plan, symptom management and triggers, sleep apnoea, weight loss, AF procedures). 2. Text message: after three failed call attempts a text message will be sent containing a link to a survey. This survey will have all the content addressed in the automated phone call, however in a written format, with options for patients to self-report using multiple choice answers instead of verbally. Each outreach will cover different goals and AF-related information: - Outreach 1 – assessment of overall health, blood thinner medicines, rhythm control medicines, understanding your AF type - Outreach 2 – assessment of AF symptoms, blood pressure monitoring, blood pressure measuring techniques - Outreach 3 –AF care team, AF action plan, medication adherence - Outreach 4 – common triggers for AF, query AF symptoms management - Outreach 5 – conditions that make AF hard to control, weight management, diet and exercise - Outreach 6 – AF procedures and treatment options (cardioversion, ablation), stroke information All outreaches will collect information about participant satisfaction with the call, by asking them to rate the outreach, on a scale of 1 to 5 – 1 being not helpful and 5 being very helpful. ALERTS Based on patient responses to the questions asked in the outreaches, certain answers will trigger an alert to the central clinical management team, these include: - If participant reports that their overall health is 1 or 2 (out of 5) and wants to discuss this further - If participant is NOT SURE that they are on blood thinner medications and wants to discuss this further - If participant’s symptoms are SIGNIFICANTLY impacting their daily life and wants to discuss this further - If participant is UNABLE to manage their symptoms and wants to discuss this further These alerts will be sent directly to the central clinical management team based at the Westmead Applied Research Centre (Westmead Hospital), University of Sydney. Alerts will be followed up by a phone call from an appropriate member from the clinical research team within 1-2 business days, with escalation to a doctor when required. EDUCATIONAL TEXT MESSAGES In addition to these outreaches, educational text messages will be sent to intervention group participants with AF-related information. The topics of information will include blood thinning and rhythm control medication, stroke risk, high blood pressure and AF, managing medications, AF triggers (alcohol, caffeine, illness, sleep, stress, anxiety), sleep apnoea information, losing weight, cardioversions, cardiac ablation, pacemakers. Text messages will be brief and engaging, and some will include external links to online resources, videos, webpages (e.g. Heart Foundation). A total of 27 educational text messages (2-3 per week) will be sent over the 3-month intervention. MONITORING OF INTERVENTION ADHERENCE Intervention usage metrics will be automatically collected. A log report of the automated phone calls will contain details such as call answered/unanswered, call duration, and number of queries answered. An electronic log will record the time messages are sent and the status of the delivery (i.e. delivered or not delivered). A log of responses received from participants and when participants contact the study team, including the reason for contact and the method used will also be kept.