Abstract Funding Acknowledgements Type of funding sources: None. Background TeleCheck-AF is a novel remote on-demand mobile health (mHealth) infrastructure supporting teleconsultations. During the COVID-19 pandemic, social media (SoMe) communication on Twitter contributed to the rapid dissemination and implementation of this health care innovation into 41 European hospitals by using the hashtag #TeleCheckAF. Purpose To (1) analyze the SoMe Twitter network behind #TeleCheckAF, (2) describe the communities and behavioral groups within the network and (3) to determine the opinion leaders and influencers. Methods Publicly available data on actors and interactions within the #TeleCheckAF SoMe network was collected by web-scraping from the platform Twitter. This included all public tweets that used the hashtag #TeleCheckAF including their meta-data. Based on this, a node list (Twitter accounts) and an edge list (ties between accounts) as well as a social network were created. The position of an actor in the network and an actor’s opinion leadership was analyzed with the help of centrality measures (i.e. degree centrality, closeness centrality, betweenness centrality). Communities, or groups of nodes that were highly connected to each other, were further assessed by a modularity algorithm. Behavioral groups were analyzed based on participation in the healthcare innovation TeleCheck-AF (active participation) and dissemination of #TeleCheckAF on Twitter. Three behavioral groups were defined: Diffusers (dissemination but no active participation), adopters (no dissemination but active participation) and communicative adopters (dissemination and active participation). Results The network consisted of 413 086 nodes and 636 502 edges. 287 actors within the SoMe Twitter network behind #TeleCheckAF, who were either diffusers, adopters or communicative adopters, were further analyzed. Twenty-two different communities and 20 opinion leaders were identified. Peaks in Twitter activity could be temporally related to (inter-,)national virtual conferences, where results on TeleCheck-AF were presented. Two official European Society of Cardiology (ESC) Twitter handles and two Twitter handles of ESC SoMe supervisors and ESC Journal SoMe editors were among the group of opinion leaders reflecting the effect of the ESC SoMe promotion strategy. Overall, not only professionals directly involved in the TeleCheck-AF project, but also different other stakeholders such as allied health professionals or health technology companies were represented within the network. Conclusion The SoMe network behind #TeleCheckAF showed a wide dissemination involving a broad spectrum of healthcare professionals and was accelerated by the official ESC Twitter handles. Social network analysis created a helpful insight into the mechanisms behind innovation dissemination within social media. Future research could further analyze the difssemination process using e.g. hazard modeling and investigate the evolution of the network and behaviors over time. Figure 1: Cumulative tweet frequency

Abstract Funding Acknowledgements Type of funding sources: None. Background TeleCheck-AF is a digital care pathway, which consists of a structured teleconsultation ("Tele") preceded by an app-based on-demand heart rate and rhythm monitoring infrastructure ("Check") and the consecutive integration of the app-derived findings in a comprehensive atrial fibrillation (AF) management. Purpose To evaluate changes in healthcare utilisation and declarable care products during the implementation of the TeleCheck-AF approach in a Dutch AF-clinic. Methods Healthcare provided to patients in the Netherlands is based on a diagnosis-treatment combination (Dutch: DBC). Once a patient visits the hospital, a treatment trajectory is opened, which contains the DBC care product. The DBC care products contain diagnostic and therapeutic performances for a certain diagnosis as well as information about reimbursement and are weighted in light (≤ € 200), medium (€ 300-500) and heavy (≥ € 600) depending on the performed diagnostic tests. Patients with AF who were treated with both a conventional approach in 2019 (standard care) and by the TeleCheck-AF approach in 2020 in a Dutch AF-clinic, were compared in this prospective case-crossover analysis. Healthcare utilisation in terms of numbers and modes of outpatient contacts (teleconsultation vs face-to-face), number of emergency department (ED) presentations, use of diagnostic resources (i.e. ECG, Holter) and related reimbursement were analysed. A patient experience survey which encompassed five questions regarding use of the app and patient satisfaction with the remote heart rate and rhythm control was performed. Results Ninety-one patients with AF from a Dutch AF-clinic (median age 68 years; 43% women) were analysed. Within the conventional approach in 2019, 113 face-to-face consultations and 1 teleconsultation were performed. After the implementation of TeleCheck-AF in 2020 the number of face-to-face consultations reduced by 53% and teleconsultations increased by 2900%. While 151 ECGs and 42 Holter-ECGs were performed within the conventional approach, the number of ECGs in the TeleCheck-AF approach decreased by 48% and number of Holters decreased by 35%. ED presentations did not differ significantly in the conventional compared to TeleCheck-AF approach (22 vs 17). Patients’ satisfaction within the TeleCheck-AF approach was high. The change in healthcare utilisation in TeleCheck-AF treated patients resulted in a mutation in declarable care products weights (towards light weighted DBC) and associated reimbursement. Conclusion The implementation of TeleCheck-AF was associated with a change in health care utilisation which resulted in a disproportional drop in reimbursement by health insurances due to a shift in declarable care products weights. Results of this analysis were basis to design a new reimbursement code for the TeleCheck-AF approach in the Netherlands.

The 2012 focused update of the ESC Guidelines for the management of atrial fibrillation mainly covers the fields of anticoagulation, antiarrhythmic drug therapy, and catheter ablation. As for anticoagulation, the CHADSVASc-and the HAS-BLED-Scores for risk stratification as well as the new anticoagulants are fully introduced. Vernakalant and Dronedaron are two new antiarrhythmic drugs whose indications and contraindications are covered in the new guidelines. Finally, the role of catheter ablation as a treatment strategy for atrial fibrillation is further emphasized.