Obesity is a well-known risk factor for cardiovascular morbidities, including atrial fibrillation (AF). “The good news is obesity is reversible,” explains Andrea Natale, MD, FACC, FHRS, FESC. “If optimal weight is achieved early during the disease process, the progression of AF can be stalled, at least to some extent. However, poor compliance with weight loss measures is one of the most challenging issues when it comes to making lifestyle changes to achieve and sustain healthy weight.”

Studies have shown that patients typically are more compliant with weight loss interventions when they receive regular attention from their healthcare providers. Researchers are continuing to seek out better solutions to maintain patient engagement, and many are now focusing on digital platforms. “Digital platforms are widely used by the global population and provide an easy means of delivering health interventions,” says Mitra Mohanty, MD, MS, FHRS.

Exploring the Impact of Digital Monitoring on Engagement & Compliance

For a pilot study published in Cardiovascular Digital Health Journal, Drs. Natale and Mohanty and colleagues investigated the impact of patient engagement using a digital monitoring system on compliance for lifestyle-change measures and subsequent outcomes. “We wanted to investigate if a digital app-based monitoring system would increase patient engagement and subsequently improve compliance for lifestyle changes, including diet and physical activity,” Dr. Mohanty says.

Patients with coexistent AF and obesity were classified into two groups based on the monitoring method and were instructed to log their daily diet intake and exercise intensity. For Group 1, a digital platform with a smartphone app was used to set weekly goals for exercise and weight loss, to track compliance data continuously, and to send regular text reminders. Remote guidance and support and periodic reminders to follow lifestyle recommendations were delivered through the app. For Group 2, patients received conventional methods, which included monitoring adherence to diet and changes in weight during in-person visits or with monthly phone calls from staff.

Higher Compliance & Greater Weight Loss With App Use

“Our study showed that use of the digital app was associated with significantly higher compliance and weight loss when assessed at 6 months of follow-up,” says Dr. Mohanty. Patients from Group 1—the digital monitoring cohort—were more compliant with physician instructions regarding diet and exercise than those from Group 2 (60% vs 33%, respectively). Weight loss was observed in 75% of patients from Group 1, compared with 39% for those in Group 2. The mean reduction in weight was also higher for Group 1 than for Group 2 (Figure). The study also noted that weight loss was more prevalent and pronounced in those participating in the digital monitoring intervention than for those receiving conventional monitoring.

Consider Adopting Digital Monitoring Measures as a Part of Standard Protocols

“The findings from our study revealed that paying close attention to patients with coexistent AF and obesity by setting up weekly goals and sending text reminders to follow their given instructions could improve outcomes,” Dr. Mohanty says. “The digital apps are easy to use and help patients stay motivated to remain compliant. Importantly, the digital monitoring system is highly convenient for physicians and nurses to stay connected with their patients.”

The study group noted that the opportunity to connect with the remote lifestyle coaches when needed and the text reminders were important influences for increased patient engagement and improved compliance. “Based on our findings, clinicians should consider adopting these measures as part of their standard follow-up protocols when managing patients with coexistent AF and obesity,” says Dr. Natale.

According to the study, larger clinical trials are warranted to validate the findings. “We’re also planning to use the digital platform to survey patients on their QOL, cognitive function, and affective status,” says Dr. Natale. “Additionally, we aim to investigate patient compliance for oral anticoagulants and other therapeutics for different chronic conditions, including hypertension, diabetes, dyslipidemia, and sleep apnea.”