Remote patient monitoring for atrial fibrillation: a safety and feasibility study of a technology-enabled virtual ward
A Sekander, R Sethi, M Georgalos, Z Awadallah, C Dawson, R Ho, J Fahim, S Y Tang, U Ahmed, T Adnan, G Karagiannis, A WoodAbstract
Background
The 2024 European Society of Cardiology Atrial Fibrillation (AF) guidelines emphasise the ethos of a patient-centred approach to the management of AF and recognises telemedicine as an important part of this.1 Virtual wards, providing continuous remote monitoring and structured clinical support while avoiding unnecessary hospital admissions, can help to deliver hospital-level care for AF patients whilst improving patient experience and without the associated complications of hospital admission.2
Purpose
To describe the safety and feasibility of a novel technology-enabled virtual ward (VW) for patients with AF.
Methods
A novel technology-enabled VW was launched in a district general hospital in February 2025. All patients who would have otherwise been hospitalised for AF were screened for suitability based on three factors: 1) absence of red-flag features such as haemodynamic instability or syncope, 2) troponin negative and 3) ability to engage with the VW. Patients were enrolled from acute hospital admissions, the emergency department (ED) and outpatient clinics. On enrolment a mobile phone with a clinically validated photoplethysmography-based smartphone application was provided, through which patients submitted daily vital-sign data. Specialist nurses conducted structured telephone assessments, ‘virtual ward rounds’ at least once daily—and twice daily when clinically indicated. Each assessment included a focussed symptom assessment, comparison with the previous day’s symptoms, and any additional concerns. Weekly multi-disciplinary team meetings were also held for all patients on the VW. The VW pathway is demonstrated in Figure 1. 30-day outcome data was then collected for all patients discharged from the VW.
Results
From March 2025 to September 2025 87 patients were enrolled on the VW. 36/87 (41%) were female with a median age of 68 (IQR 59-78). 53/87 (61%) were enrolled during an acute hospital admission, 32/87 (37%) from an outpatient setting and 2/87 (2%) directly from an ED presentation. Freedom from 30-day all-cause hospitalisation was achieved in 80/87 cases (92%). (Figure 2) There were no deaths. Patients hospitalised after being discharged from the VW tended to be older in age (mean 76.2 years vs 67.0 years, p-value = 0.03). 5/87 (6%) of patients presented to ED within 30-days but were discharged. Mean length of stay on the VW was 10.3 days. Changes to AF medication occurred in 9/87 (10%) of patients- this was an increase in rate control medication in 3/87 (3%) and a decrease in 6/87 (7%).
Conclusion
An AF VW is a potentially safe and feasible method of delivering telemedicine for AF patients, although caution should be used in older patients. Further study is required to assess if this method can reduce length of inpatient stay and reduce healthcare costs.Virtual Ward Pathway30-Day Outcomes