Conversational AI Phone Calls to Support Patients With Atrial Fibrillation: Randomized Controlled Trial.

Abstract

Background: Patient education and self-management support are critical for atrial fibrillation (AF) management. Conversational artificial intelligence (AI) has the potential to provide interactive and personalized support, but has not been evaluated in patients with AF.

Objective: This study aimed to evaluate the feasibility of a conversational AI intervention to support patients with AF postdischarge.

Methods: This was a single-blinded, 4:1-parallel-randomized controlled trial with process evaluation of feasibility and engagement. The primary outcome was the change in Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire total score between groups. Patients with AF (18 y and older) were recruited postdischarge from Westmead Hospital cardiology services and randomized to receive either the intervention or usual care. The 6-month intervention consisted of fully automated conversational AI phone calls (with speech recognition and natural language processing) that regularly assessed patient health and symptoms and provided self-management support and education. These phone calls were supplemented with an online survey (sent via text message or email) containing replicated call content when participants could not be reached after 3 call attempts. If participant responses were concerning (eg, poor overall health, low medication confidence, and high symptom burden), they would be followed up with an ad hoc phone call and directed to clinical care if required. A semipersonalized education website was also available as part of the intervention, and participants were encouraged weekly (nudges delivered via text messages or emails) to visit it.

Results: A total of 103 patients (mean age, 63.7 y, SD 11.2 y; n=72, 70% male) were randomized (82 to the intervention); the target sample size was 385. The difference in the AFEQT total score was nonsignificant (adjusted mean difference 2.08, 95% CI -7.79 to 11.96; P=.46). An exploratory prepost comparison revealed an improvement in total AFEQT score in the intervention group only (baseline: 69.9, 95% CI 64.4 to 75.5; 6 months: 79.9, 95% CI 74.9 to 84.8; P=.01). Participants completed 4 of 7 outreaches on average, and 88.4% (304/344) of completed outreaches were reported as useful.

Conclusions: This proof-of-concept study demonstrates the feasibility of conversational AI in supporting patients with chronic conditions postdischarge. Intervention participants had improvement in their atrial fibrillation quality of life, though the forced shortening of the evaluation was unable to demonstrate a significant difference between groups.