ABC | Volume 110, Nº1, January 2018

Original Article Stephan et al Mobile health and atrial fibrillation Arq Bras Cardiol. 2018; 110(1):7-15 Figure 3 – Risk perception of stroke and bleeding by the patients before and after interacting with the application compared with the real risk, calculated by the CHA 2 DS 2 -VASc and HAS-BLED scores, showing a non-significant increase in the adequate perception of the risk. Comparisons were performed by the Wilcoxon test. 80% 70% 60% 50% 40% 30% 20% 10% 0% Risk of stroke Risk of bleeding p < 0.608 p < 0.218 Before the app After the app Before the app After the app 20% 30% 45% 60% Adequate risk perception 75% 70% 20% 25% Believe to have a risk lower than the real one 5% 0% 35% 15% Believe to have a risk highe than the real one Figure 2 – Mean number of correct answers in the questionnaire about the disease before (4.7) and after (7.2) the intervention, compared by the paired-sample t test, indicating a significant increase in patients’ knowledge after interacting with the application. Error bars indicate standard deviations, and circles represent the score of each patient. 8 7 6 5 4 3 2 1 0 Before the app After the app p < 0.001 Correct answers in atrial fibrillation knowledge questionnaire Several studies have mentioned instruments that facilitate shared decision-making strategies of anticoagulation in AF, by means of behavior change and patients’ education using leaflets, and interventions using videos and softwares. A Cochrane meta-analysis published in 2013 reviewed these studies, and concluded that there is no sufficient evidence that evaluate the impact of these strategies on the International Normalized Ratio in therapeutic range (TTR, time in therapeutic range). 26 Another recent review concluded that decision-making strategies with patients’ participation are powerful tools to improve the management of AF and that these instruments should be developed and tested. 18 Subsequently, the TREAT study, a randomized, controlled study of behavioral intervention in patients who had recently initiated warfarin, showed a significant improvement of TTR in six months, compared with usual care. 27 Another study involving a multidisciplinary intervention for patients with AF, which included a decision support software, and was conducted and supervised by nurses and cardiologists, respectively, demonstrated a significant reduction in the number of cardiovascular deaths and hospitalization (14.3 vs. 20.8%; risk ration of 0.65; 95% CI 0.45–0.93). 28 11