Title: User Behavior of the HeartPortal: A Log Data Analysis of Individuals with Atrial Fibrillation and Healthcare Professionals (Preprint)

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Abstract
BACKGROUND Background: Atrial fibrillation (AF) is a growing global health challenge associated with substantial morbidity, reduced quality of life, and increased healthcare utilization. Digital health technologies applied to telerehabilitation have shown the potential to support individuals’ engagement and enhanced self‑management during rehabilitation. However, little is known about how individuals with AF use digital platforms in real‑world settings, and log‑file analyses remain underexplored. OBJECTIVE Objective: This study aimed to elucidate how individuals with AF engaged with a digital connection to the healthcare system. This connection was provided through the HeartPortal, a web based platform offering clinically validated educational material, access to patient reported and device generated health data, and secure communication channels that support coordination of rehabilitation activities. The study examined how participants accessed educational materials, reviewed their personal health data, and communicated with healthcare professionals throughout a 28 week telerehabilitation program. METHODS Methods: This study analyzed log file data from 101 participants enrolled in the intervention group of the Future Patient—Telerehabilitation of Patients with AF (FP AF) randomized controlled trial. Log data was generated through participants’ use of the HeartPortal. Log data included timestamps for page visits, messaging activity, video consultations, and patients’ written narratives of goals and notes. Descriptive statistics were generated using Python to quantify usage patterns across features, weekly activity levels, and temporal trends. An additional analysis examined how activity was distributed across participants, assessing whether HeartPortal visits and messaging activity were driven by a small subset of highly active users or more evenly shared across the cohort. Data was supplemented with system level information on healthcare professional activity. RESULTS Results: HeartPortal use peaked during the first 17 weeks, when over 80% of participants accessed the platform weekly, and decreased after monitoring equipment was returned. Activity in the most frequently used sections varied markedly, with the most active 25% maintaining higher engagement throughout the intervention. Participants sent 1,167 messages and healthcare professionals sent 1,705, with messaging peaking in week 6. CONCLUSIONS Conclusions: The HeartPortal was primarily used for reviewing personal health data and communicating with healthcare professionals, indicating that digital platforms can support self management in AF telerehabilitation. Limited engagement with educational content may reflect patients’ existing knowledge at baseline or a need to refine digital learning components to better match users’ needs. These findings demonstrate the value of log file analysis for understanding real world behaviour and point to future research on how digital platforms can sustain engagement and enhance patient education. CLINICALTRIAL Name: Future Patient - Telerehabilitation of Atrial Fibrillation Patients ClinicalTrials.gov (NCT04493437) URL: https://clinicaltrials.gov/study/NCT04493437 INTERNATIONAL REGISTERED REPORT RR2-10.2196/64259

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