ABC | Volume 110, Nº1, January 2018

Original Article Stephan et al Mobile health and atrial fibrillation Arq Bras Cardiol. 2018; 110(1):7-15 Methods Development of the application The development staff was composed by a cardiologist, an electrophysiologist, a software developer and a designer. First, the following fundamental aspects were defined: condition/problem to be approached (thromboembolic prophylaxis in AF); target users/population (patients with AF and low socioeconomic and cultural status); initial application targets (increased knowledge about disease and treatment); situation in which the app would be used (during medical visits); device in which the app would be installed (doctor’s tablet computer) and programming languages (Android and iOS). A comprehensive literature review was performed, including the main randomized clinical trials, systematic reviews, meta-analyses, and guidelines on AF and OAC, which provided the main scores to be used and relevant information to be conveyed to the users. Aiming to translate this information into knowledge to the patient, a simplified navigation through five screens (Figure 1): (1) Knowing the disease – a video about how AF occurs and how it can cause a thromboembolic event; (2) Individualizing the risks – a calculator integrated with the CHA 2 DS 2 -VASc, HAS-BLED and SAMe-TT2R2 11 scores; (3) Understanding risks and benefits – a screen with pictograms to visualize the percentage of the risk of stroke and bleeding in each treatment option; (4) Knowing the treatment option – a summary of the main characteristics of the drugs available; and (5) Making a choice – the final screen, in which information is saved and the number of patient’s cell phone may be registered to receive information via Short Message Service (SMS). This navigation format emphasized the main points, providing additional access to more detailed information through the links, according to the users’ needs. For example, in the area of medications, data of posology, approximate costs, advantages and disadvantages of each drug were informed. Also, the official package insert of the drug provided by the Brazilian National Health Surveillance Agency was accessible through a link. Push technology by SMS is a strategy used to enhance the provision of information without overloading the patient with information in only one meeting. In this technology, the patient periodically receives alerts on the importance of adhering to drug therapy and doing some tests, as well as disease information, which can be saved in message box for further reading by the patient. Figure 1 – Main screens of the aFib app, developed to help in the shared decision about thromboembolic prophylaxis in atrial fibrillation. 8