Andi Eie Albertsen

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

The Danish Pacemaker and ICD Register (DPIR) was established in 1982 as a hardware registry and clinical quality database dedicated to cardiac implantable electronic device (CIED) therapy. It is among the most comprehensive and longest-running CIED registries in the world and has recorded over 200,000 CIED procedures in more than 133,000 individuals. Leveraging the Danish registry infrastructure, individual-level linkage to other national clinical and administrative registries via the unique personal identification number greatly expands its research potential. This review summarizes the development, database structure, variable content and quality, and the clinical and scientific impact of DPIR. Examples of data quality include complete national coverage of all CIED procedures, standardized data-entry fields that minimize variability across centers, mandatory reporting of core variables, and high concordance between registry entries and source documentation. Data from DPIR has informed clinical practice guidelines and supported clinical quality improvement in Denmark and internationally. The graphical abstract is divided into two sections. The left highlights features of a complete national cohort: nationwide coverage, detailed patient, device, and procedural data, linkage to national databases and registries, and high variable completeness and accuracy. The right focuses on clinical aspects: clinical follow-up, safety monitoring, quality assurance (hand icon), and epidemiological research.Graphical abstract highlighting key strengths and characteristics of the Danish Pacemaker and ICD Register.

Background: Atrial fibrillation (AF) is a prevalent chronic condition with increasing incidence worldwide. AF increases the risks of stroke, heart failure, and myocardial infarction and imposes a substantial burden on the health care system. Cardiac rehabilitation programs, while effective, often have low patient adherence. Recent evidence suggests that cardiac telerehabilitation, where patients are given home monitoring devices, could enhance adherence and outcomes. The program “Future Patient—Telerehabilitation of Patients with AF” (FP-AF) was created to assess the effects and potential benefits of cardiac telerehabilitation on patients with AF. Objective: The objective of this study is to explore the experiences of patients participating in the FP-AF program. Methods: This qualitative sub-study is part of the multicenter, randomized controlled FP-AF trial, which included 208 patients. Semi-structured interviews were conducted on 14 patients, randomly selected from participants in the intervention arm of the FP-AF program. The patient interviews, guided by self-determination theory, focused on patients’ experiences with the FP-AF program, including the use of telerehabilitation technologies and a web-based portal called the “HeartPortal.” Interview responses were analyzed using NVivo software (version 14.0; QSR International), with thematic coding based on interview guides and methodological guidance elaborated by Brinkmann & Kvale. The study adhered to ethical guidelines, with informed consent obtained from all participants. Results: Based on the interviews, the following themes were identified: the home monitoring devices are viewed positively by the patients; the HeartPortal is a useful digital toolbox; patients develop new coping strategies for living with AF; the measured values are useful for the patients; the community of practice is beneficial; and the FP-AF program creates a sense of security. Conclusions: Participation in the FP-AF program enhanced patients’ sense of security, empowerment, and knowledge about AF. This improvement was due largely to a combination of patients’ use of the HeartPortal and the educational sessions at health care centers. Telerehabilitation for patients with AF may be a useful way of researching this group of patients with a focus on rehabilitation and may be an effective means of offering rehabilitation to this group in the future.

Background: Atrial fibrillation (AF) is a chronic cardiovascular condition with a lifetime risk of 1 in 3 and a prevalence of 3% among adults. AF’s prevalence is predicted to more than double during the next 20 years due to better detection, increasing comorbidities, and an aging population. Due to increased AF prevalence, telerehabilitation has been developed to enhance patient engagement, health care accessibility, and compliance through digital technologies. A telerehabilitation program called “Future Patient—telerehabilitation of patients with AF (FP-AF)” has been developed to enhance rehabilitation for AF. The FP-AF program comprises two modules: (1) an education and monitoring module using telerehabilitation technologies (4 months) and (2) a follow-up module, where patients can measure steps and access a data and knowledge-sharing portal, HeartPortal, using their digital devices. Those patients in the FP-AF program measure their heart rhythm, pulse, blood pressure, weight, steps, and sleep. Patients also complete web-based questionnaires regarding their well-being and coping with AF. All recorded data are transmitted to the HeartPortal, accessible to patients, relatives, and health care professionals. Objective: This paper aims to describe the research design, outcome measures, and data collection techniques in a clinical trial of the FP-AF program for patients with AF. Methods: This is a multicenter, mixed methods, randomized controlled trial. Patients are recruited from AF clinics serving the North Jutland region of Denmark. The telerehabilitation group will participate in the FP-AF program, while the control group will follow the conventional care regime based on physical visits to the AF clinic. The primary outcome measure is AF-specific health-related quality of life, to be assessed using the Atrial Fibrillation Effect on Quality-of-Life Questionnaire. Secondary outcomes are knowledge of AF; measurement of vital parameters; level of anxiety and depression; degree of motivation; burden of AF; use of the HeartPortal; qualitative exploration of patients’, relatives’, and health care professionals’ experiences of participating in the FP-AF program; cost-effectiveness evaluation of the program; and analysis of multiparametric monitoring data. Outcomes are assessed through data from digital technologies, interviews, and questionnaires. Results: Patient enrollment began in January 2023 and will be completed by December 2024, with a total of 208 patients enrolled. Qualitative interviews conducted in spring 2024 will be analyzed and published in peer-reviewed journals in 2025. Data from questionnaires and digital technologies will be analyzed upon study completion and presented at international conferences and published in peer-reviewed journals by the fall of 2025. Conclusions: Results from the FP-AF study will determine whether the FP-AF program can increase quality of life for patients with AF and increase their knowledge of symptoms and living with AF in everyday life compared to conventional AF care. The cost-effectiveness evaluation will determine whether telerehabilitation can be a viable alternative for rehabilitation of patients with AF. Trial Registration: ClinicalTrials.gov NCT06101485; https://clinicaltrials.gov/study/NCT06101485 International Registered Report Identifier (IRRID): DERR1-10.2196/64259

BACKGROUND Atrial fibrillation (AF) is a prevalent chronic condition with increasing incidence worldwide. AF increases the risks of stroke, heart failure, and myocardial infarction and imposes a substantial burden on the healthcare system. Cardiac rehabilitation programs, while effective, often suffer from low patient adherence. Recent evidence suggests that cardiac telerehabilitation, where patients are given home monitoring devices, could enhance adherence and outcomes. The program ‘Future Patient – Telerehabilitation of patients with AF’ (FP-AF) was created to assess the effects and potential benefits of cardiac telerehabilitation on AF patients. This study explores patient experiences with the FP-AF program. OBJECTIVE To explore the experiences of patients participating in the FP-AF program. METHODS This qualitative sub-study is part of the multicenter, randomized controlled FP-AF trial, which included 208 patients. Semi-structured interviews were conducted on 14 patients, randomly selected from participants in the intervention arm of the FP-AF program. The patient interviews, guided by self-determination theory, focused on patients' experiences with the FP-AF program, including the use of telerehabilitation technologies and an interactive web portal called the ‘HeartPortal’. Interview responses were analyzed using NVivo software, with thematic coding based on interview guides and methodological guidance elaborated by Brinkmann & Kvale. The study adhered to ethical guidelines, with informed consent obtained from all participants. RESULTS Based on the interviews, the following themes were identified: The home monitoring devices are viewed positively by the patients, the HeartPortal is a useful digital toolbox, patients develop new coping strategies for living with AF, the measured values are useful for the patients, the community of practice is beneficial, the FP-AF program creates a sense of security. CONCLUSIONS Patients’ participation in the FP-AF program enhanced their sense of security, empowerment, and knowledge about AF. This improvement was largely due to a combination of patients’ use of the HeartPortal and the educational sessions held at the healthcare centers. Telerehabilitation for patients with AF has the potential to be an effective means of offering rehabilitation to this group in the future. CLINICALTRIAL The FP-AF study is listed in ClinicalTrials.gov (NCT06101485) INTERNATIONAL REGISTERED REPORT RR2-10.2196/64259

BACKGROUND Atrial fibrillation (AF) is a chronic cardiovascular condition with a lifetime risk of 1 in 3 and a prevalence of 3% among adults. AF’s prevalence is predicted to more than double during the next 20 years due to better detection, increasing comorbidities, and an aging population. Due to increased AF prevalence, telerehabilitation has been developed to enhance patient engagement, health care accessibility, and compliance through digital technologies. A telerehabilitation program called “Future Patient—telerehabilitation of patients with AF (FP-AF)” has been developed to enhance rehabilitation for AF. The FP-AF program comprises two modules: (1) an education and monitoring module using telerehabilitation technologies (4 months) and (2) a follow-up module, where patients can measure steps and access a data and knowledge-sharing portal, HeartPortal, using their digital devices. Those patients in the FP-AF program measure their heart rhythm, pulse, blood pressure, weight, steps, and sleep. Patients also complete web-based questionnaires regarding their well-being and coping with AF. All recorded data are transmitted to the HeartPortal, accessible to patients, relatives, and health care professionals. OBJECTIVE This paper aims to describe the research design, outcome measures, and data collection techniques in a clinical trial of the FP-AF program for patients with AF. METHODS This is a multicenter, mixed methods, randomized controlled trial. Patients are recruited from AF clinics serving the North Jutland region of Denmark. The telerehabilitation group will participate in the FP-AF program, while the control group will follow the conventional care regime based on physical visits to the AF clinic. The primary outcome measure is AF-specific health-related quality of life, to be assessed using the Atrial Fibrillation Effect on Quality-of-Life Questionnaire. Secondary outcomes are knowledge of AF; measurement of vital parameters; level of anxiety and depression; degree of motivation; burden of AF; use of the HeartPortal; qualitative exploration of patients’, relatives’, and health care professionals’ experiences of participating in the FP-AF program; cost-effectiveness evaluation of the program; and analysis of multiparametric monitoring data. Outcomes are assessed through data from digital technologies, interviews, and questionnaires. RESULTS Patient enrollment began in January 2023 and will be completed by December 2024, with a total of 208 patients enrolled. Qualitative interviews conducted in spring 2024 will be analyzed and published in peer-reviewed journals in 2025. Data from questionnaires and digital technologies will be analyzed upon study completion and presented at international conferences and published in peer-reviewed journals by the fall of 2025. CONCLUSIONS Results from the FP-AF study will determine whether the FP-AF program can increase quality of life for patients with AF and increase their knowledge of symptoms and living with AF in everyday life compared to conventional AF care. The cost-effectiveness evaluation will determine whether telerehabilitation can be a viable alternative for rehabilitation of patients with AF. CLINICALTRIAL ClinicalTrials.gov NCT06101485; https://clinicaltrials.gov/study/NCT06101485 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/64259

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules. Objective: The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF. Methods: This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients’ perspectives. Secondary outcomes were the development of patients’ knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0. Results: Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups. Conclusions: Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient–TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04493437; https://clinicaltrials.gov/ct2/show/NCT04493437.

BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia and is predicted to more than double in prevalence over the next 20 years. Tailored patient education is recommended as an important aspect of AF care. Current guidelines emphasize that patients become more active participants in the management of their own disease, yet there are no rehabilitation programs for patients with AF in the Danish health care system. Through participatory design, we developed the Future Patient Telerehabilitation (TR) Programs, A and B, for patients with AF. The 2 programs are based on HeartPortal and remote monitoring, together with educational modules. OBJECTIVE The aim of this pilot study is to evaluate and compare the feasibility of the 2 programs of TR for patients with AF. METHODS This pilot study was conducted between December 2019 and March 2020. The pilot study consisted of testing the 2 TR programs, A and B, in two phases: (1) treatment at the AF clinic and (2) TR at home. The primary outcome of the study was the usability of technologies for self-monitoring and the context of the TR programs as seen from patients’ perspectives. Secondary outcomes were the development of patients’ knowledge of AF, development of clinical data, and understanding the expectations and experiences of patients and spouses. Data were collected through interviews, questionnaires, and clinical measurements from home monitoring devices. Statistical analyses were performed using the IBM SPSS Statistics version 26. Qualitative data were analyzed using NVivo 12.0. RESULTS Through interviews, patients articulated the following themes about participating in a TR program: usefulness of the HeartPortal, feeling more secure living with AF, community of practice living with AF, and measuring heart rhythm makes good sense. Through interviews, the spouses of patients with AF expressed that they had gained increased knowledge about AF and how to support their spouses living with AF in everyday life. Results from the responses to the Jessa AF Knowledge Questionnaire support the qualitative data, as they showed that patients in program B acquired increased knowledge about AF at follow-up compared with baseline. No significant differences were found in the number of electrocardiography recordings between the 2 groups. CONCLUSIONS Patients with AF and their spouses were positive about the TR program and they found the TR program useful, especially because it created an increased sense of security, knowledge about mastering their symptoms, and a community of practice linking patients with AF and their spouses and health care personnel. To assess all the benefits of the Future Patient–TR Program for patients with AF, it needs to be tested in a comprehensive randomized controlled trial. CLINICALTRIAL ClinicalTrials.gov NCT04493437; https://clinicaltrials.gov/ct2/show/NCT04493437.

Purpose: Remote monitoring are routinely used for follow-up of patients with implantable cardioverter defibrillators and cardiac resynchronization therapy devices. Patients eligible for conventional permanent pacemaker are often hospitalized for two days. There is a trend to reduce hospital overnight stays and reorganize procedures to an out patient setting. We hypothesized that remote monitoring in an outpatient setup can replace hospitalization in patients eligible for permanent pacemaker. Methods: Sixty-two consecutive patients receiving a permanent pacemaker because of sick sinus syndrome or mild AV-block were included. Patients were received in the outpatient clinic in the morning. After a successful pacemaker implantation patients were send home with a remote monitoring system. The remote systems were forced to deliver all relevant technical measurements the following morning. The primary endpoint was a successful remote follow-up within 24 hours after pacemaker implantation. The patient was contacted by phone when the measurements were received in the clinic the next day. In case of incomplete or missing data trouble shooting was done by phone. Results: In total 62 patients were included. Baseline data and follow-up results are shown in figure. No complications related to the implantation were observed. Successful follow-up were done in 60% of patients. Challenges remained in 40% of patients because of lack of transmission, missing threshold or missing EGM often solved by simple trouble shooting. Patients reported high satisfaction with the remote setup to replace hospitalization. Conclusions: Implantation of permanent pacemakers in an outpatient setting with subsequent remote monitoring is a safe alternative to conventional in-hospital implantation. However, some challenges exist in receiving immediate (< 24 h), complete transmissions.