Evaluation of an Internet-based educational programme in patients with atrial fibrillation (ASK FOR IT)

Patient education is an important component of integrated atrial fibrillation (AF) care. Whether education reduces symptoms and improves health-related quality of life (HRQoL) in patients with AF requires further evaluation.

To assess whether the AF-specific Internet-based educational programme (ASK FOR IT) will reduce symptoms and improve HRQoL.

The study was a randomised, controlled, open, prospective, multicentre trial. Patients planned for direct current cardioversion of AF and/or antiarrhythmic medication were included in the study. The primary outcome was improvement in the arrhythmia-specific questionnaire (ASTA) symptom scale score at 12 months in the intervention arm compared to the control arm.

Two hundred and one patients were randomised, 99 to the ASK FOR IT programme and 102 to the control group. The mean age was 67 years, and 40% were female. Baseline characteristics were comparable between the two arms. At 12 months, 69% were in sinus rhythm in the intervention group, and 67% in the control group.

The primary endpoint, the ASTA symptom scale score, showed a significant improvement across the entire cohort one year after the initiation of the programme compared to baseline (28.5 vs. 19.4; p<0.001). However, no significant difference was observed between the intervention and control groups regarding the ASTA symptom scale score (28.0 vs. 19.4 for the intervention group; 29.0 vs. 19.5 for the control group; p=0.708).

The secondary endpoint, the ASTA HRQoL scale score and its two subscales (physical and mental), demonstrated a significant improvement after one year for all patients (23.9 vs. 13.7; p<0.001). No significant difference was observed between the randomisation groups regarding the ASTA HRQoL scale score (22.4 vs. 12.5 for the intervention group; 25.3 vs. 15 for the control group; p=0.873).

No statistically significant differences were observed between the intervention and control groups for the other tested questionnaires: SF-36, EQ-5D-5L, VAS, and HADS.

All patients improved in symptoms and HRQoL over time, but the AF-specific internet-based educational programme had no additional effect on the improvement in symptoms and HRQoL at 12 months. The high percentage of patients in sinus rhythm at follow-up may partly explain the lack of effect of the intervention.