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Santala OE, Lipponen JA, Jäntti H, Rissanen TT, Tarvainen MP, Väliaho ES, Rantula OA, Naukkarinen NS, Hartikainen JEK, Martikainen TJ, Halonen J. Novel Technologies in the Detection of Atrial Fibrillation: Review of Literature and Comparison of Different Novel Technologies for Screening of Atrial Fibrillation. Cardiol Rev 2024; 32:440-447. [PMID: 36946975 PMCID: PMC11296284 DOI: 10.1097/crd.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Atrial fibrillation (AF) is globally the most common arrhythmia associated with significant morbidity and mortality. It impairs the quality of the patient's life, imposing a remarkable burden on public health, and the healthcare budget. The detection of AF is important in the decision to initiate anticoagulation therapy to prevent thromboembolic events. Nonetheless, AF detection is still a major clinical challenge as AF is often paroxysmal and asymptomatic. AF screening recommendations include opportunistic or systematic screening in patients ≥65 years of age or in those individuals with other characteristics pointing to an increased risk of stroke. The popularities of well-being and taking personal responsibility for one's own health are reflected in the continuous development and growth of mobile health technologies. These novel mobile health technologies could provide a cost-effective solution for AF screening and an additional opportunity to detect AF, particularly its paroxysmal and asymptomatic forms.
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Affiliation(s)
- Onni E. Santala
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka A. Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika P. Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Eemu-Samuli Väliaho
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli A. Rantula
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Noora S. Naukkarinen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha E. K. Hartikainen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | | | - Jari Halonen
- From the School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
- Heart Center, Kuopio University Hospital, Kuopio, Finland
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Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024:ehae176. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Jones ID, Lane DA, Lotto RR, Oxborough D, Neubeck L, Penson PE, Smith EJ, Santos A, McGinn EE, Ajiboye A, Town N, Czanner G, Shaw A, El-Masri H, Lip GYH. Supermarket/hypermarket opportunistic screening for atrial fibrillation (SHOPS-AF) using sensors embedded in the handles of supermarket trolleys: A feasibility study. Am Heart J 2024; 271:164-177. [PMID: 38395294 DOI: 10.1016/j.ahj.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) increases the risk of death, stroke, heart failure, cognitive decline, and healthcare costs but is often asymptomatic and undiagnosed. There is currently no national screening program for AF. The advent of validated hand-held devices allows AF to be detected in non-healthcare settings, enabling screening to be undertaken within the community. METHOD AND RESULTS In this novel observational study, we embedded a MyDiagnostick single lead ECG sensor into the handles of shopping trolleys in four supermarkets in the Northwest of England: 2155 participants were recruited. Of these, 231 participants either activated the sensor or had an irregular pulse, suggesting AF. Some participants agreed to use the sensor but refused to provide their contact details, or consent to pulse assessment. In addition, some data were missing, resulting in 203 participants being included in the final analyses. Fifty-nine participants (mean age 73.6 years, 43% female) were confirmed or suspected of having AF; 20 were known to have AF and 39 were previously undiagnosed. There was no evidence of AF in 115 participants and the remaining 46 recordings were non-diagnostic, mainly due to artefact. Men and older participants were significantly more likely to have newly diagnosed AF. Due to the number of non-diagnostic ECGs (n = 46), we completed three levels of analyses, excluding all non-diagnostic ECGs, assuming all non-diagnostic ECGs were masking AF, and assuming all non-diagnostic ECGs were not AF. Based on the results of the three analyses, the sensor's sensitivity (95% CI) ranged from 0.70 to 0.93; specificity from 0.15 to 0.97; positive predictive values (PPV) and negative predictive values (NPV) ranged from 0.24 to 0.56 and 0.55 to 1.00, respectively. These values should be interpreted with caution, as the ideal reference standard on 1934 participants was imperfect. CONCLUSION The study demonstrates that the public will engage with AF screening undertaken as part of their daily routines using hand-held devices. Sensors can play a key role in identifying asymptomatic patients in this way, but the technology must be further developed to reduce the quantity of non-diagnostic ECGs.
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Affiliation(s)
- Ian D Jones
- School of Nursing and Advanced Practice, Faculty of Health, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK.
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Robyn R Lotto
- School of Nursing and Advanced Practice, Faculty of Health, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - David Oxborough
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; School of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Peter E Penson
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
| | - Emma Johnston Smith
- School of Nursing and Advanced Practice, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Aimeris Santos
- School of Nursing and Advanced Practice, Faculty of Health, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Emily E McGinn
- School of Nursing and Advanced Practice, Faculty of Health, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Aderonke Ajiboye
- School of Nursing and Advanced Practice, Faculty of Health, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Nicola Town
- School of Nursing and Advanced Practice, Faculty of Health, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gabriela Czanner
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, UK; Faculty of Informatics and Information Technology, Slovak University of Technology, Bratislava, Slovakia
| | - Andy Shaw
- School of Civil Engineering and Built Environment, Liverpool John Moores University, Liverpool, UK
| | - Hala El-Masri
- School of Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Cross B, Turner RM, Zhang JE, Pirmohamed M. Being precise with anticoagulation to reduce adverse drug reactions: are we there yet? THE PHARMACOGENOMICS JOURNAL 2024; 24:7. [PMID: 38443337 PMCID: PMC10914631 DOI: 10.1038/s41397-024-00329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
Anticoagulants are potent therapeutics widely used in medical and surgical settings, and the amount spent on anticoagulation is rising. Although warfarin remains a widely prescribed oral anticoagulant, prescriptions of direct oral anticoagulants (DOACs) have increased rapidly. Heparin-based parenteral anticoagulants include both unfractionated and low molecular weight heparins (LMWHs). In clinical practice, anticoagulants are generally well tolerated, although interindividual variability in response is apparent. This variability in anticoagulant response can lead to serious incident thrombosis, haemorrhage and off-target adverse reactions such as heparin-induced thrombocytopaenia (HIT). This review seeks to highlight the genetic, environmental and clinical factors associated with variability in anticoagulant response, and review the current evidence base for tailoring the drug, dose, and/or monitoring decisions to identified patient subgroups to improve anticoagulant safety. Areas that would benefit from further research are also identified. Validated variants in VKORC1, CYP2C9 and CYP4F2 constitute biomarkers for differential warfarin response and genotype-informed warfarin dosing has been shown to reduce adverse clinical events. Polymorphisms in CES1 appear relevant to dabigatran exposure but the genetic studies focusing on clinical outcomes such as bleeding are sparse. The influence of body weight on LMWH response merits further attention, as does the relationship between anti-Xa levels and clinical outcomes. Ultimately, safe and effective anticoagulation requires both a deeper parsing of factors contributing to variable response, and further prospective studies to determine optimal therapeutic strategies in identified higher risk subgroups.
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Affiliation(s)
- Benjamin Cross
- Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Richard M Turner
- Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
- GSK, Stevenage, Hertfordshire, SG1 2NY, UK
| | - J Eunice Zhang
- Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, 1-5 Brownlow Street, Liverpool, L69 3GL, UK
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, Institute of Systems, Molecular and Integrative Biology, The University of Liverpool, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
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Malmqvist J, Engdahl J, Sjölund G, Doliwa P. Sensitivity and specificity of handheld one lead ECG detecting atrial fibrillation in an outpatient clinic setting. J Electrocardiol 2024; 83:106-110. [PMID: 38412780 DOI: 10.1016/j.jelectrocard.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 02/29/2024]
Abstract
AIMS To validate the sensitivity and specificity of the Zenicor One handheld ECG device for detection of atrial fibrillation in an outpatient clinical setting. METHODS AND RESULTS Patients attending outpatient clinics at Danderyd Hospital (n = 220) were examined with one lead handheld ECG immediately after standard care 12‑lead ECG recording. Twelve recordings were excluded (atrial flutter or pacing) or missing. The recordings were dichotomously categorized as "atrial fibrillation" or "not atrial fibrillation" by two senior cardiologists. In cases of diverging interpretations, a third senior cardiologist had the deciding vote. Sensitivity and specificity in diagnosing atrial fibrillation was calculated with 12‑lead ECG as gold standard. Sensitivity and specificity for diagnosis of atrial fibrillation with one lead handheld ECG and 12‑lead ECG as gold standard was 98% and 99% respectively. CONCLUSION In a health-care outpatient setting, Zenicor One handheld ECG had high sensitivity and specificity for detection of atrial fibrillation when compared with 12‑lead ECG.
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Affiliation(s)
- Johan Malmqvist
- Karolinska Institutet, Dept of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Dept of Clinical Physiology, Danderyd University Hospital, Stockholm, Sweden.
| | - Johan Engdahl
- Karolinska Institutet, Dept of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Dept of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gunnar Sjölund
- Dept of Clinical Physiology, Danderyd University Hospital, Stockholm, Sweden
| | - Piotr Doliwa
- Karolinska Institutet, Dept of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden; Dept of Cardiology, Danderyd University Hospital, Stockholm, Sweden
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Baptista R, Silva Cardoso J, Canhão H, Maria Rodrigues A, Kislaya I, Franco F, Bernardo F, Pimenta J, Mendes L, Gonçalves S, Teresa Timóteo A, Andrade A, Moura B, Fonseca C, Aguiar C, Brito D, Ferreira J, Filipe Azevedo L, Peres M, Santos P, Moraes Sarmento P, Cernadas R, Santos M, Fontes-Carvalho R, Campos Fernandes A, Martinho H, González-Juanatey JR, Filipe Pereira L, Gil V, Raquel Marques C, Almeida M, Pardal M, Barbosa V, Gavina C. Portuguese Heart Failure Prevalence Observational Study (PORTHOS) rationale and design - A population-based study. Rev Port Cardiol 2023; 42:985-995. [PMID: 37918783 DOI: 10.1016/j.repc.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Current epidemiological data on heart failure (HF) in Portugal derives from studies conducted two decades ago. The main aim of this study is to determine HF prevalence in the Portuguese population. Using current standards, this manuscript aims to describe the methodology and research protocol applied. METHODS The Portuguese Heart Failure Prevalence Observational Study (PORTHOS) is a large, three-stage, population-based, nationwide, cross-sectional study. Community-dwelling citizens aged 50 years and older will be randomly selected via stratified multistage sampling. Eligible participants will be invited to attend a screening visit at a mobile clinic for HF symptom assessment, anthropomorphic assessment, N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing, one-lead electrocardiogram (ECG) and a sociodemographic and health-related quality of life questionnaire (EQ-5D). All subjects with NT-proBNP ≥125 pg/mL or with a prior history of HF will undergo a diagnostic confirmatory assessment at the mobile clinic composed of a 12-lead ECG, comprehensive echocardiography, HF questionnaire (KCCQ) and blood sampling. To validate the screening procedure, a control group will undergo the same diagnostic assessment. Echocardiography results will be centrally validated, and HF diagnosis will be established according to the European Society of Cardiology HF guidelines. A random subsample of patients with an equivocal HF with preserved ejection fraction diagnosis based on the application of the Heart Failure Association preserved ejection fraction diagnostic algorithm will be invited to undergo an exercise echocardiography. CONCLUSIONS Through the application of current standards, appropriate methodologies, and a strong research protocol, the PORTHOS study will determine the prevalence of HF in mainland Portugal and enable a comprehensive characterization of HF patients, leading to a better understanding of their clinical profile and health-related quality of life.
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Affiliation(s)
- Rui Baptista
- Department of Cardiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; University of Coimbra, Center for Innovative Biomedicine and Biotechnology (CIBB), Coimbra, Portugal; Clinical Academic Center of Coimbra (CACC), Coimbra, Portugal.
| | - José Silva Cardoso
- Faculdade de Medicina, Universidade do Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Universitário de São João, Oporto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Oporto, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Rheumatology Unit, Centro Hospitalar Universitário de Lisboa Central, Santo António Capuchos Hospital, Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Irina Kislaya
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Epidemiology, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal; Public Health Research Center, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Fátima Franco
- Unidade de Tratamento de Insuficiência Cardiaca Avançada (UTICA), Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Joana Pimenta
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Oporto, Portugal; Department of Internal Medicine, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Lígia Mendes
- Department of Cardiology, Hospital da Luz Setúbal, Setúbal, Portugal; Faculdade de Medicina, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Sara Gonçalves
- Unidade Integrada de Insuficiência Cardíaca (UNIICA), Department of Cardiology, Centro Hospitalar de Setúbal EPE, Setúbal, Portugal
| | - Ana Teresa Timóteo
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Aurora Andrade
- Clínica de Insuficiência Cardíaca, Department of Cardiology, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | | | - Cândida Fonseca
- Department of Medicine, Clínica de Insuficiência Cardiaca, Hospital S. Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Clínica de Insuficiência Cardiaca, Department of Cardiology, Hospital da Luz, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carlos Aguiar
- Unidade de Insuficiência Cardíaca Avançada, Department of Cardiology, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Dulce Brito
- Department of Cardiology, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), CAML, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jorge Ferreira
- Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Luís Filipe Azevedo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIS), Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde & Laboratório Associado - Rede de Investigação em Saúde (CINTESIS@RISE), Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal
| | - Marisa Peres
- Department of Cardiology, Hospital de Santarém, Santarém, Portugal
| | - Paulo Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIS), Faculdade de Medicina da Universidade do Porto (FMUP), Oporto, Portugal; Center for Health Technology and Services Research (CINTESIS), Faculdade de Medicina, Universidade do Porto, Oporto, Portugal
| | - Pedro Moraes Sarmento
- Clínica de Insuficiência Cardiaca, Department of Cardiology, Hospital da Luz, Lisbon, Portugal; Faculdade de Medicina, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal; Centro de Investigação Clinica, Hospital da Luz Learning Health, Lisbon, Portugal
| | - Rui Cernadas
- Serviços de Saúde Ocupacional, Continental Mabor, Lousado, Portugal
| | - Mário Santos
- Department of Cardiology, Pulmonary Vascular Disease Unit, Centro Hospitalar Universitário de Santo António, Oporto, Portugal; CAC ICBAS-CHP - Centro Académico Clínico Instituto de Ciências Biomédicas Abel Salazar - Centro Hospitalar Universitário de Santo António, Oporto, Portugal; Department of Immuno-Physiology and Pharmacology, UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Oporto, Portugal; ITR - Laboratory for Integrative and Translational Research in Population Health, Oporto, Portugal
| | - Ricardo Fontes-Carvalho
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Oporto, Portugal; Department of Cardiology, Centro Hospitalar Vila Nova de Gaia-Espinho, Oporto, Portugal
| | | | | | - José Ramon González-Juanatey
- Cardiology Department, Complejo Hospitalario de la Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Luís Filipe Pereira
- Associação de Apoio aos Doentes com Insuficiência Cardiaca (AADIC), Lisbon, Portugal
| | - Victor Gil
- Cardiovascular Department, Hospital da Luz-Lisboa, Lisbon, Portugal; Faculdade de Medicina, Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Cláudia Raquel Marques
- National Center for Data Collection in Cardiology, Portuguese Society of Cardiology, Coimbra, Portugal
| | | | | | | | - Cristina Gavina
- Pedro Hispano Hospital - ULS Matosinhos, Matosinhos, Portugal; Cardiology Department, Faculty of Medicine, University of Porto, Oporto, Portugal; RISE- Health Research Network, Faculty of Medicine, University of Porto, Oporto, Portugal
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Zepeda-Echavarria A, van de Leur RR, van Sleuwen M, Hassink RJ, Wildbergh TX, Doevendans PA, Jaspers J, van Es R. Electrocardiogram Devices for Home Use: Technological and Clinical Scoping Review. JMIR Cardio 2023; 7:e44003. [PMID: 37418308 PMCID: PMC10362423 DOI: 10.2196/44003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/29/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Electrocardiograms (ECGs) are used by physicians to record, monitor, and diagnose the electrical activity of the heart. Recent technological advances have allowed ECG devices to move out of the clinic and into the home environment. There is a great variety of mobile ECG devices with the capabilities to be used in home environments. OBJECTIVE This scoping review aimed to provide a comprehensive overview of the current landscape of mobile ECG devices, including the technology used, intended clinical use, and available clinical evidence. METHODS We conducted a scoping review to identify studies concerning mobile ECG devices in the electronic database PubMed. Secondarily, an internet search was performed to identify other ECG devices available in the market. We summarized the devices' technical information and usability characteristics based on manufacturer data such as datasheets and user manuals. For each device, we searched for clinical evidence on the capabilities to record heart disorders by performing individual searches in PubMed and ClinicalTrials.gov, as well as the Food and Drug Administration (FDA) 510(k) Premarket Notification and De Novo databases. RESULTS From the PubMed database and internet search, we identified 58 ECG devices with available manufacturer information. Technical characteristics such as shape, number of electrodes, and signal processing influence the capabilities of the devices to record cardiac disorders. Of the 58 devices, only 26 (45%) had clinical evidence available regarding their ability to detect heart disorders such as rhythm disorders, more specifically atrial fibrillation. CONCLUSIONS ECG devices available in the market are mainly intended to be used for the detection of arrhythmias. No devices are intended to be used for the detection of other cardiac disorders. Technical and design characteristics influence the intended use of the devices and use environments. For mobile ECG devices to be intended to detect other cardiac disorders, challenges regarding signal processing and sensor characteristics should be solved to increase their detection capabilities. Devices recently released include the use of other sensors on ECG devices to increase their detection capabilities.
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Affiliation(s)
- Alejandra Zepeda-Echavarria
- Medical Technologies and Clinical Physics, Facilitation Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rutger R van de Leur
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Meike van Sleuwen
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rutger J Hassink
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
- HeartEye BV, Delft, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Joris Jaspers
- Medical Technologies and Clinical Physics, Facilitation Department, University Medical Center Utrecht, Utrecht, Netherlands
| | - René van Es
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, Netherlands
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Yeo C, Mon AA, Tan VH, Wong K. Validation of MyDiagnostick tool to identify atrial fibrillation in a multi-ethnic Asian population. Singapore Med J 2023; 64:430-433. [PMID: 35196846 PMCID: PMC10395807 DOI: 10.11622/smedj.2022028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/25/2020] [Indexed: 11/18/2022]
Abstract
Introduction MyDiagnostick is an atrial fibrillation (AF) screening tool that has been validated in the Caucasian population in the primary care setting. Methods In our study, we compared MyDiagnostick with manual pulse check for AF screening in the community setting. Results In our cohort of 671 candidates from a multi-ethnic Asian population, AF prevalence was found to be 1.78%. Of 12 candidates, 6 (50.0%) had a previous history of AF and another 6 (50.0%) were newly diagnosed with AF. Candidates found to have AF during the screening were older (72.0 ± 11.7 years vs. 56.0 ± 13.0 years, P < 0.0001) and had a higher CHADSVASC risk score (2.9 ± 1.5 vs. 1.5 ± 1.1, P = 0.0001). MyDiagnostick had a sensitivity of 100.0% and a specificity of 96.2%. In comparison, manual pulse check had a sensitivity of 83.3% and a specificity of 98.9%. Conclusion MyDiagnostick is a simple AF screening device that can be reliably used by non-specialist professionals in the community setting. Its sensitivity and specificity are comparable and validated across various studies performed in different population cohorts.
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Affiliation(s)
- Colin Yeo
- Cardiology Department, Changi General Hospital, Singapore
| | - Aye Aye Mon
- Cardiology Department, Changi General Hospital, Singapore
| | - Vern Hsen Tan
- Cardiology Department, Changi General Hospital, Singapore
| | - Kelvin Wong
- Cardiology Department, Changi General Hospital, Singapore
- Orchard Heart Specialist Clinic, Mount Elizabeth Hospital, Singapore
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Protocol for a Systematic Review and Individual Participant Data Meta-Analysis of Randomized Trials of Screening for Atrial Fibrillation to Prevent Stroke. Thromb Haemost 2023; 123:366-376. [PMID: 36863334 PMCID: PMC9981276 DOI: 10.1055/s-0042-1760257] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Atrial fibrillation (AF) is a common cause of stroke. Timely diagnosis of AF and treatment with oral anticoagulation (OAC) can prevent up to two-thirds of AF-related strokes. Ambulatory electrocardiographic (ECG) monitoring can identify undiagnosed AF in at-risk individuals, but the impact of population-based ECG screening on stroke is uncertain, as ongoing and published randomized controlled trials (RCTs) have generally been underpowered for stroke. METHODS AND ANALYSIS The AF-SCREEN Collaboration, with support from AFFECT-EU, have begun a systematic review and individual participant data meta-analysis of RCTs evaluating ECG screening for AF. The primary outcome is stroke. Secondary outcomes include AF detection, OAC prescription, hospitalization, mortality, and bleeding.After developing a common data dictionary, anonymized data will be collated from individual trials into a central database. We will assess risk of bias using the Cochrane Collaboration tool, and overall quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation approach.We will pool data using random effects models. Prespecified subgroup and multilevel meta-regression analyses will explore heterogeneity. We will perform prespecified trial sequential meta-analyses of published trials to determine when the optimal information size has been reached, and account for unpublished trials using the SAMURAI approach. IMPACT AND DISSEMINATION Individual participant data meta-analysis will generate adequate power to assess the risks and benefits of AF screening. Meta-regression will permit exploration of the specific patient, screening methodology, and health system factors that influence outcomes. TRIAL REGISTRATION NUMBER PROSPERO CRD42022310308.
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10
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Paul Nordin A, Carnlöf C, Insulander P, Mohammad Ali A, Jensen-Urstad M, Saluveer O, Drca N. Validation of diagnostic accuracy of a handheld, smartphone-based rhythm recording device. Expert Rev Med Devices 2023; 20:55-61. [PMID: 36695787 DOI: 10.1080/17434440.2023.2171290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM Evaluation of the diagnostic accuracy of a rhythm recording device, for detection of atrial tachyarrhythmia (ATA) and atrial fibrillation (AF) compared to 12-lead-electrocardiogram (12-L-ECG). RESEARCH DESIGN AND METHODS Two hundred 12-L-ECGs (reference standard) and Coala Heart Monitor (CHM) recordings (index test) were collected from 189 patients. Two electrophysiologists independently performed manual analysis of all 12-L-ECGs and CHM recordings in random order. The CHM recordings were also analyzed by an automatic algorithm and compared to the results of the reference standard. RESULTS Manual analysis of CHM for ATA showed a sensitivity of 98.9% (95% confidence interval (CI): 94.0-100) and a specificity of 100% (CI: 96.6-100). Manual analysis for AF had a sensitivity of 100% (CI: 95.3-100) and a specificity of 97.5% (CI: 93.0-99.5). Automatic analysis for ATA showed a sensitivity of 93.5% (CI: 86.3-97.6) and a specificity of 92.6% (CI: 85.9-96.7). Automatic analysis for AF showed a sensitivity of 97.4% (CI: 91.0-99.7) and a specificity of 86.1% (CI: 78.6-91.7). CONCLUSION CHM has a very high accuracy for ATA and AF in manual analysis and a high accuracy for ATA and AF in automatic analysis, making the device suitable for screening.
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Affiliation(s)
- Astrid Paul Nordin
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Carina Carnlöf
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Amina Mohammad Ali
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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11
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Lawin D, Kuhn S, Schulze Lammers S, Lawrenz T, Stellbrink C. Use of digital health applications for the detection of atrial fibrillation. Herzschrittmacherther Elektrophysiol 2022; 33:373-379. [PMID: 35960358 DOI: 10.1007/s00399-022-00888-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
The advances in health care technologies over the last decade have led to improved capabilities in the use of digital health applications (DiHA) for the detection of atrial fibrillation (AFib). Thus, home-based remote heart rhythm monitoring is facilitated by smartphones or smartwatches alone or combined with external sensors. The available products differ in terms of type of application (wearable vs. handheld) and the technique used for rhythm detection (electrocardiography [ECG] vs. photoplethysmography [PPG]). While ECG-based algorithms often require additional sensors, PPG utilizes techniques integrated in smartphones or smartwatches. Algorithms based on artificial intelligence allow for the automated diagnosis of AFib, enabling high diagnostic accuracy for both ECG-based and PPG-based DiHA. Advantages for clinical use result from the widespread accessibility of rhythm monitoring, thereby permitting earlier diagnosis and higher AFib detection rates. DiHA are also useful for the follow-up of patients with known AFib by monitoring the success of therapeutic interventions to restore sinus rhythm, e.g. catheter ablation. Although some studies strongly suggest a potential benefit for the use of DiHA in the setting of AFib, the overall evidence for an improvement in hard, clinical endpoints and positive effects on clinical care is scarce. To enhance the acceptance of DiHA use in daily practice, more studies evaluating their clinical benefits for the detection of AFib are required. Moreover, most of the applications are still not reimbursable, although the German Digital Health Care Act (Digitale-Versorgung-Gesetz, DVG) made reimbursement possible in principle in 2019.
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Affiliation(s)
- Dennis Lawin
- Department of Cardiology and Intensive Care Medicine, University hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany.
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany.
| | - Sebastian Kuhn
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Sophia Schulze Lammers
- Department of Cardiology and Intensive Care Medicine, University hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Thorsten Lawrenz
- Department of Cardiology and Intensive Care Medicine, University hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, University hospital OWL of Bielefeld University, Campus Klinikum Bielefeld, Teutoburger Str. 50, 33604, Bielefeld, Germany
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12
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Campo D, Elie V, de Gallard T, Bartet P, Morichau-Beauchant T, Genain N, Fayol A, Fouassier D, Pasteur-Rousseau A, Puymirat E, Nahum J. Atrial Fibrillation Detection With an Analog Smartwatch: Prospective Clinical Study and Algorithm Validation. JMIR Form Res 2022; 6:e37280. [PMID: 35481559 PMCID: PMC9675016 DOI: 10.2196/37280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atrial fibrillation affects approximately 4% of the world's population and is one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. It can be difficult to diagnose when asymptomatic or in the paroxysmal stage, and its natural history is not well understood. New wearables and connected devices offer an opportunity to improve on this situation. OBJECTIVE We aimed to validate an algorithm for the automatic detection of atrial fibrillation from a single-lead electrocardiogram taken with a smartwatch. METHODS Eligible patients were recruited from 4 sites in Paris, France. Electrocardiograms (12-lead reference and single lead) were captured simultaneously. The electrocardiograms were reviewed by independent, blinded board-certified cardiologists. The sensitivity and specificity of the algorithm to detect atrial fibrillation and normal sinus rhythm were calculated. The quality of single-lead electrocardiograms (visibility and polarity of waves, interval durations, heart rate) was assessed in comparison with the gold standard (12-lead electrocardiogram). RESULTS A total of 262 patients (atrial fibrillation: n=100, age: mean 74.3 years, SD 12.3; normal sinus rhythm: n=113, age: 61.8 years, SD 14.3; other arrhythmia: n=45, 66.9 years, SD 15.2; unreadable electrocardiograms: n=4) were included in the final analysis; 6.9% (18/262) were classified as Noise by the algorithm. Excluding other arrhythmias and Noise, the sensitivity for atrial fibrillation detection was 0.963 (95% CI lower bound 0.894), and the specificity was 1.000 (95% CI lower bound 0.967). Visibility and polarity accuracies were similar (1-lead electrocardiogram: P waves: 96.9%, QRS complexes: 99.2%, T waves: 91.2%; 12-lead electrocardiogram: P waves: 100%, QRS complexes: 98.8%, T waves: 99.5%). P-wave visibility accuracy was 99% (99/100) for patients with atrial fibrillation and 95.7% (155/162) for patients with normal sinus rhythm, other arrhythmias, and unreadable electrocardiograms. The absolute values of the mean differences in PR duration and QRS width were <3 ms, and more than 97% were <40 ms. The mean difference between the heart rates from the 1-lead electrocardiogram calculated by the algorithm and those calculated by cardiologists was 0.55 bpm. CONCLUSIONS The algorithm demonstrated great diagnostic performance for atrial fibrillation detection. The smartwatch's single-lead electrocardiogram also demonstrated good quality for physician use in daily routine care. TRIAL REGISTRATION ClinicalTrials.gov NCT04351386; http://clinicaltrials.gov/ct2/show/NCT04351386.
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Affiliation(s)
| | | | | | | | | | | | - Antoine Fayol
- Cardiology Intensive Care Unit, Hopital Europeen Georges Pompidou, Paris, France
| | | | | | - Etienne Puymirat
- Cardiology Intensive Care Unit, Hopital Europeen Georges Pompidou, Paris, France
| | - Julien Nahum
- Intensive Care Unit, Centre Cardiologique du Nord, Sainte-Denis, France
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13
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Theunissen LJHJ, Abdalrahim RBEM, Dekker LRC, Thijssen EJM, de Jong SFAMS, Polak PE, van de Voort PH, Smits G, Scheele K, Lucas A, van Veghel DPA, Cremers HP, van de Pol JAA, Kemps HMC. Regional implementation of atrial fibrillation screening: benefits and pitfalls. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:570-577. [PMID: 36710905 PMCID: PMC9779812 DOI: 10.1093/ehjdh/ztac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/15/2022] [Indexed: 11/06/2022]
Abstract
Aims Despite general awareness that screening for atrial fibrillation (AF) could reduce health hazards, large-scale implementation is lagging behind technological developments. As the successful implementation of a screening programme remains challenging, this study aims to identify facilitating and inhibiting factors from healthcare providers' perspectives. Methods and results A mixed-methods approach was used to gather data among practice nurses in primary care in the southern region of the Netherlands to evaluate the implementation of an ongoing single-lead electrocardiogram (ECG)-based AF screening programme. Potential facilitating and inhibiting factors were evaluated using online questionnaires (N = 74/75%) and 14 (of 24) semi-structured in-depth interviews (58.3%). All analyses were performed using SPSS 26.0. In total, 16 682 screenings were performed on an eligible population of 64 000, and 100 new AF cases were detected. Facilitating factors included 'receiving clear instructions' (mean ± SD; 4.12 ± 1.05), 'easy use of the ECG-based device' (4.58 ± 0.68), and 'patient satisfaction' (4.22 ± 0.65). Inhibiting factors were 'time availability' (3.20 ± 1.10), 'insufficient feedback to the practice nurse' (2.15 ± 0.89), 'absence of coordination' (54%), and the 'lack of fitting policy' (32%). Conclusion Large-scale regional implementation of an AF screening programme in primary care resulted in a low participation of all eligible patients. Based on the perceived barriers by healthcare providers, future AF screening programmes should create preconditions to fit the intervention into daily routines, appointing an overall project lead and a General Practitioner (GP) as a coordinator within every GP practice.
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Affiliation(s)
- Luc J H J Theunissen
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Máxima Medical Centre, De Run 4600, 5504DB, Veldhoven, The Netherlands,Department of Electrical Engineering, Technical University, 5612 AZ, Eindhoven, The Netherlands
| | - Reyan B E M Abdalrahim
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Department of Electrical Engineering, Technical University, 5612 AZ, Eindhoven, The Netherlands
| | - Lukas R C Dekker
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Department of Electrical Engineering, Technical University, 5612 AZ, Eindhoven, The Netherlands,Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Eric J M Thijssen
- Máxima Medical Centre, De Run 4600, 5504DB, Veldhoven, The Netherlands
| | | | - Peter E Polak
- St. Anna hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | | | - Geert Smits
- GP Organization PoZoB, Bolwerk 10-14, 5509 MH, Veldhoven, The Netherlands
| | - Karin Scheele
- GP Organization PoZoB, Bolwerk 10-14, 5509 MH, Veldhoven, The Netherlands
| | - Annelies Lucas
- Diagnostics for You, Boschdijk 1119, 5626 AG, Eindhoven, The Netherlands
| | - Dennis P A van Veghel
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Catharina hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | | | - Hareld M C Kemps
- Netherlands Heart Network, De Run 4600, 5504 DB, Veldhoven, The Netherlands,Máxima Medical Centre, De Run 4600, 5504DB, Veldhoven, The Netherlands,Department of Industrial Design, Eindhoven University of Technology, 5612 AZ, Eindhoven, The Netherlands
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14
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Garikapati K, Turnbull S, Bennett RG, Campbell TG, Kanawati J, Wong MS, Thomas SP, Chow CK, Kumar S. The Role of Contemporary Wearable and Handheld Devices in the Diagnosis and Management of Cardiac Arrhythmias. Heart Lung Circ 2022; 31:1432-1449. [PMID: 36109292 DOI: 10.1016/j.hlc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/18/2022] [Accepted: 08/01/2022] [Indexed: 10/14/2022]
Abstract
Cardiac arrhythmias are associated with significant morbidity, mortality and economic burden on the health care system. Detection and surveillance of cardiac arrhythmias using medical grade non-invasive methods (electrocardiogram, Holter monitoring) is the accepted standard of care. Whilst their accuracy is excellent, significant limitations remain in terms of accessibility, ease of use, cost, and a suboptimal diagnostic yield (up to ∼50%) which is critically dependent on the duration of monitoring. Contemporary wearable and handheld devices that utilise photoplethysmography and the electrocardiogram present a novel opportunity for remote screening and diagnosis of arrhythmias. They have significant advantages in terms of accessibility and availability with the potential of enhancing the diagnostic yield of episodic arrhythmias. However, there is limited data on the accuracy and diagnostic utility of these devices and their role in therapeutic decision making in clinical practice remains unclear. Evidence is mounting that they may be useful in screening for atrial fibrillation, and anecdotally, for the diagnosis of other brady and tachyarrhythmias. Recently, there has been an explosion of patient uptake of such devices for self-monitoring of arrhythmias. Frequently, the clinician is presented such information for review and comment, which may influence clinical decisions about treatment. Further studies are needed before incorporation of such technologies in routine clinical practice, given the lack of systematic data on their accuracy and utility. Moreover, challenges with regulation of quality standards and privacy remain. This state-of-the-art review summarises the role of novel ambulatory, commercially available, heart rhythm monitors in the diagnosis and management of cardiac arrhythmias and their expanding role in the diagnostic and therapeutic paradigm in cardiology.
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Affiliation(s)
- Kartheek Garikapati
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW Australia
| | - Samual Turnbull
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW Australia
| | - Richard G Bennett
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW Australia
| | - Timothy G Campbell
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW Australia
| | - Juliana Kanawati
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW Australia
| | - Mary S Wong
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW Australia
| | - Stuart P Thomas
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW Australia
| | - Clara K Chow
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW Australia
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Sydney, NSW Australia.
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15
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Palà E, Bustamante A, Clúa-Espuny JL, Acosta J, González-Loyola F, Santos SD, Ribas-Segui D, Ballesta-Ors J, Penalba A, Giralt M, Lechuga-Duran I, Gentille-Lorente D, Pedrote A, Muñoz MÁ, Montaner J. Blood-biomarkers and devices for atrial fibrillation screening: Lessons learned from the AFRICAT (Atrial Fibrillation Research In CATalonia) study. PLoS One 2022; 17:e0273571. [PMID: 35998199 PMCID: PMC9398023 DOI: 10.1371/journal.pone.0273571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background and objective
AFRICAT is a prospective cohort study intending to develop an atrial fibrillation (AF) screening program through the combination of blood markers, rhythm detection devices, and long-term monitoring in our community. In particular, we aimed to validate the use of NT-proBNP, and identify new blood biomarkers associated with AF. Also, we aimed to compare AF detection using various wearables and long-term Holter monitoring.
Methods
359 subjects aged 65–75 years with hypertension and diabetes were included in two phases: Phase I (n = 100) and Phase II (n = 259). AF diagnosis was performed by baseline 12-lead ECG, 4 weeks of Holter monitoring (NuuboTM), and/or medical history. An aptamer array including 1310 proteins was measured in the blood of 26 patients. Candidates were selected according to p-value, logFC and biological function to be tested in verification and validation phases. Several screening devices were tested and compared: AliveCor, Watch BP, MyDiagnostick and Fibricheck.
Results
AF was present in 34 subjects (9.47%). The aptamer array revealed 41 proteins with differential expression in AF individuals. TIMP-2 and ST-2 were the most promising candidates in the verification analysis, but none of them was further validated. NT-proBNP (log-transformed) (OR = 1.934; p<0.001) was the only independent biomarker to detect AF in the whole cohort. Compared to an ECG, WatchBP had the highest sensitivity (84.6%) and AUC (0.895 [0.780–1]), while MyDiagnostick showed the highest specificity (97.10%).
Conclusion
The inclusion and monitoring of a cohort of primary care patients for AF detection, together with the testing of biomarkers and screening devices provided useful lessons about AF screening in our community. An AF screening strategy using rhythm detection devices and short monitoring periods among high-risk patients with high NT-proBNP levels could be feasible.
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Affiliation(s)
- Elena Palà
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Alejandro Bustamante
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain
- Stroke Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
- * E-mail:
| | - Josep Lluis Clúa-Espuny
- Equip d’Atenció Primària Tortosa Est, SAP Terres de l’Ebre, Institut Català de la Salut, Tortosa, Spain
- Institut d’Investigació en Atenció Primària IDIAP Jordi Gol, Unitat de Suport a la Recerca de Barcelona, Barcelona, Spain
| | - Juan Acosta
- Department of cardiology, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Felipe González-Loyola
- Institut d’Investigació en Atenció Primària IDIAP Jordi Gol, Unitat de Suport a la Recerca de Barcelona, Barcelona, Spain
- Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Sara Dos Santos
- CAP Horta 7F, Àmbit d’Atenció Primària Barcelona ciutat, Institut Català de la Salut, Barcelona, Spain
| | | | - Juan Ballesta-Ors
- Equip d’Atenció Primària Tortosa Est, SAP Terres de l’Ebre, Institut Català de la Salut, Tortosa, Spain
- Institut d’Investigació en Atenció Primària IDIAP Jordi Gol, Unitat de Suport a la Recerca de Barcelona, Barcelona, Spain
| | - Anna Penalba
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Marina Giralt
- Biochemical department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Iñigo Lechuga-Duran
- Servicio Cardiología, Hospital Virgen De La Cinta, Institut Català Salut Tortosa, Tarragona, Spain
| | - Delicia Gentille-Lorente
- Servicio Cardiología, Hospital Virgen De La Cinta, Institut Català Salut Tortosa, Tarragona, Spain
| | - Alonso Pedrote
- Department of cardiology, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - Miguel Ángel Muñoz
- Institut d’Investigació en Atenció Primària IDIAP Jordi Gol, Unitat de Suport a la Recerca de Barcelona, Barcelona, Spain
- Gerència Atenció Primària de Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR)-Universitat Autónoma de Barcelona, Barcelona, Spain
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville & Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
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16
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Svennberg E, Tjong F, Goette A, Akoum N, Di Biase L, Bordachar P, Boriani G, Burri H, Conte G, Deharo JC, Deneke T, Drossart I, Duncker D, Han JK, Heidbuchel H, Jais P, de Oliviera Figueiredo MJ, Linz D, Lip GYH, Malaczynska-Rajpold K, Márquez M, Ploem C, Soejima K, Stiles MK, Wierda E, Vernooy K, Leclercq C, Meyer C, Pisani C, Pak HN, Gupta D, Pürerfellner H, Crijns HJGM, Chavez EA, Willems S, Waldmann V, Dekker L, Wan E, Kavoor P, Turagam MK, Sinner M. How to use digital devices to detect and manage arrhythmias: an EHRA practical guide. Europace 2022; 24:979-1005. [PMID: 35368065 DOI: 10.1093/europace/euac038] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Emma Svennberg
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Fleur Tjong
- Heart Center, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Andreas Goette
- St. Vincenz Hospital Paderborn, Paderborn, Germany
- MAESTRIA Consortium/AFNET, Münster, Germany
| | - Nazem Akoum
- Heart Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Haran Burri
- Cardiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Giulio Conte
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Jean Claude Deharo
- Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France
- Aix Marseille Université, C2VN, Marseille, France
| | - Thomas Deneke
- Heart Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Inga Drossart
- European Society of Cardiology, Sophia Antipolis, France
- ESC Patient Forum, Sophia Antipolis, France
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Janet K Han
- Cardiac Arrhythmia Centers, Veterans Affairs Greater Los Angeles Healthcare System and University of California, Los Angeles, CA, USA
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Cardiovascular Research Group, Antwerp University, Antwerp, Belgium
| | - Pierre Jais
- Bordeaux University Hospital, Bordeaux, France
| | | | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Manlio Márquez
- Department of Electrocardiology, Instituto Nacional de Cardiología, Mexico City, Mexico
| | - Corrette Ploem
- Department of Ethics, Law and Medical Humanities, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Kyoko Soejima
- Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Martin K Stiles
- Waikato Clinical School, University of Auckland, Hamilton, New Zealand
| | - Eric Wierda
- Department of Cardiology, Dijklander Hospital, Hoorn, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital University of Düsseldorf, Düsseldorf, Germany
| | - Cristiano Pisani
- Arrhythmia Unit, Heart Institute, InCor, University of São Paulo Medical School, São Paulo, Brazil
| | - Hui Nam Pak
- Yonsei University, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Dhiraj Gupta
- Faculty of Health and Life Sciences, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK
| | | | - H J G M Crijns
- Em. Professor of Cardiology, University of Maastricht, Maastricht, Netherlands
| | - Edgar Antezana Chavez
- Division of Cardiology, Hospital General de Agudos Dr. Cosme Argerich, Pi y Margall 750, C1155AHB Buenos Aires, Argentina
- Division of Cardiology, Hospital Belga, Antezana 455, C0000 Cochabamba, Bolivia
| | | | - Victor Waldmann
- Electrophysiology Unit, European Georges Pompidou Hospital, Paris, France
- Adult Congenital Heart Disease Unit, European Georges Pompidou Hospital, Paris, France
| | - Lukas Dekker
- Catharina Ziekenhuis Eindhoven, Eindhoven, Netherlands
| | - Elaine Wan
- Cardiology and Cardiac Electrophysiology, Columbia University, New York, NY, USA
| | - Pramesh Kavoor
- Cardiology Department, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Moritz Sinner
- Univ. Hospital Munich, Campus Grosshadern, Munich, Germany
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17
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Santala OE, Lipponen JA, Jäntti H, Rissanen TT, Tarvainen MP, Laitinen TP, Laitinen TM, Castrén M, Väliaho ES, Rantula OA, Naukkarinen NS, Hartikainen JEK, Halonen J, Martikainen TJ. Continuous mHealth Patch Monitoring for the Algorithm-Based Detection of Atrial Fibrillation: Feasibility and Diagnostic Accuracy Study. JMIR Cardio 2022; 6:e31230. [PMID: 35727618 PMCID: PMC9257607 DOI: 10.2196/31230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/27/2021] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background The detection of atrial fibrillation (AF) is a major clinical challenge as AF is often paroxysmal and asymptomatic. Novel mobile health (mHealth) technologies could provide a cost-effective and reliable solution for AF screening. However, many of these techniques have not been clinically validated. Objective The purpose of this study is to evaluate the feasibility and reliability of artificial intelligence (AI) arrhythmia analysis for AF detection with an mHealth patch device designed for personal well-being. Methods Patients (N=178) with an AF (n=79, 44%) or sinus rhythm (n=99, 56%) were recruited from the emergency care department. A single-lead, 24-hour, electrocardiogram-based heart rate variability (HRV) measurement was recorded with the mHealth patch device and analyzed with a novel AI arrhythmia analysis software. Simultaneously registered 3-lead electrocardiograms (Holter) served as the gold standard for the final rhythm diagnostics. Results Of the HRV data produced by the single-lead mHealth patch, 81.5% (3099/3802 hours) were interpretable, and the subject-based median for interpretable HRV data was 99% (25th percentile=77% and 75th percentile=100%). The AI arrhythmia detection algorithm detected AF correctly in all patients in the AF group and suggested the presence of AF in 5 patients in the control group, resulting in a subject-based AF detection accuracy of 97.2%, a sensitivity of 100%, and a specificity of 94.9%. The time-based AF detection accuracy, sensitivity, and specificity of the AI arrhythmia detection algorithm were 98.7%, 99.6%, and 98.0%, respectively. Conclusions The 24-hour HRV monitoring by the mHealth patch device enabled accurate automatic AF detection. Thus, the wearable mHealth patch device with AI arrhythmia analysis is a novel method for AF screening. Trial Registration ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335
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Affiliation(s)
- Onni E Santala
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jukka A Lipponen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | | | - Mika P Tarvainen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tomi P Laitinen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Maaret Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eemu-Samuli Väliaho
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Olli A Rantula
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Noora S Naukkarinen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Doctoral School, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juha E K Hartikainen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Jari Halonen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.,Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tero J Martikainen
- Department of Emergency Care, Kuopio University Hospital, Kuopio, Finland
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18
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Performance of the imPulse device for the detection of atrial fibrillation in hospital settings. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:171-178. [PMID: 36046429 PMCID: PMC9422064 DOI: 10.1016/j.cvdhj.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Atrial fibrillation (AF) increases thromboembolism and stroke risk; this can be reduced by oral anticoagulation, but only if AF is detected. A portable, point-of-care device, capable of accurately detecting and identifying AF, could reduce workload and diagnostic delay by minimizing need for follow-up 12-lead electrocardiogram (ECGs). Objective To assess the diagnostic performance of the Plessey imPulse lead I ECG device compared with a 12-lead ECG in detecting AF. Methods Cross-sectional diagnostic accuracy study. Participants underwent simultaneous 12-lead ECG and imPulse device recordings. The imPulse device reports AF to be “probable,” “possible,” “unlikely,” or “uncontrolled AF unlikely.” imPulse and ECG reference results were cross-tabulated; sensitivity, specificity, positive/negative predictive values, and positive/negative likelihood ratios with 95% confidence interval (CI) were estimated based on different imPulse device report categorizations and heart rate subgroups. Results A total of 217 participants were recruited (mean age 70.2 [standard deviation 12.7]), 56% male, 57% outpatients, 43% inpatients) and 199 were included in analyses. AF was diagnosed on ECG for 41 of 199 (20.6%) participants and reported by imPulse as possible, probable, or uncontrolled AF unlikely present for 49 of 199 (24.6%). Sensitivity and specificity for imPulse detection of possible, probable, or uncontrolled AF unlikely vs unlikely, compared with ECG, were 80.5% (95% CI, 65.1%–91.2%) and 89.9% (84.1%–94.1%), respectively. When probable or uncontrolled AF unlikely were compared vs possible or unlikely AF, sensitivity and specificity were 63.4% (46.9%–77.9%) and 98.1% (94.6%–99.6%), respectively. Conclusion The imPulse device has moderate sensitivity and good specificity compared with ECG AF detection in a hospital setting.
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19
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Mehrang S, Jafari Tadi M, Knuutila T, Jaakkola J, Jaakola S, Kiviniemi T, Vasankari T, Airaksinen J, Koivisto T, Pänkäälä M. End-to-end sensor fusion and classification of atrial fibrillation using deep neural networks and smartphone mechanocardiography. Physiol Meas 2022; 43. [PMID: 35413698 DOI: 10.1088/1361-6579/ac66ba] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/12/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The purpose of this research is to develop a new deep learning framework for detecting atrial fibrillation (AFib), one of the most common heart arrhythmias, by analyzing the heart's mechanical functioning as reflected in seismocardiography (SCG) and gyrocardiography (GCG) signals. Jointly, SCG and GCG constitute the concept of mechanocardiography (MCG), a method used to measure precordial vibrations with the built-in inertial sensors of smartphones. APPROACH We present a modified deep residual neural network model for the classification of sinus rhythm (SR), AFib, and Noise categories from tri-axial SCG and GCG data derived from smartphones. In the model presented, pre-processing including automated early sensor fusion and spatial feature extraction are carried out using attention-based convolutional and residual blocks. Additionally, we use bidirectional long short-term memory layers on top of fully-connected layers to extract both spatial and spatiotemporal features of the multidimensional SCG and GCG signals. The dataset consisted of 728 short measurements recorded from 300 patients. Further, the measurements were divided into disjoint training, validation, and test sets, respectively, of 481 measurements, 140 measurements, and 107 measurements. Prior to ingestion by the model, measurements were split into 10-second segments with 75 percent overlap, pre-processed, and augmented. MAIN RESULTS On the unseen test set, the model delivered average micro- and macro-F1-score of 0.88 (0.87-0.89; 95% CI) and 0.83 (0.83-0.84; 95% CI) for the segment-wise classification as well as 0.95 (0.94-0.96; 95% CI) and 0.95 (0.94-0.96; 95% CI) for the measurement-wise classification, respectively. SIGNIFICANCE Our method not only can effectively fuse SCG and GCG signals but also can identify heart rhythms and abnormalities in the MCG signals with remarkable accuracy.
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Affiliation(s)
- Saeed Mehrang
- Department of Computing, Turun Yliopisto, Yliopistonmäki, 20500 Vesilinnantie 5, Turku, 20500, FINLAND
| | - Mojtaba Jafari Tadi
- Turun Yliopisto, Yliopistonmäki, 20500 Vesilinnantie 5, Turku, 20500, FINLAND
| | - Timo Knuutila
- Turun Yliopisto, Yliopistonmäki, 20500 Vesilinnantie 5, Turku, 20014, FINLAND
| | - Jussi Jaakkola
- TYKS Turku University Hospital, Hämeentie 11, Turku, Varsinais-Suomi, 20521, FINLAND
| | | | | | - Tuija Vasankari
- Department of Internal Medicine Division of Cardiology, TYKS Turku University Hospital, Hämeentie 11, Turku, Varsinais-Suomi, 20521, FINLAND
| | - Juhani Airaksinen
- Department of Internal Medicine Division of Cardiology, TYKS Turku University Hospital, Hämeentie 11, Turku, Varsinais-Suomi, 20521, FINLAND
| | - Tero Koivisto
- Turun Yliopisto, Yliopistonmäki, 20500 Vesilinnantie 5, Turku, 20500, FINLAND
| | - Mikko Pänkäälä
- Turun Yliopisto, Yliopistonmäki, 20500 Vesilinnantie 5, Turku, 20500, FINLAND
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20
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Jones ID, Lane DA, Lotto RR, Oxborough D, Neubeck L, Penson PE, Czanner G, Shaw A, Johnston Smith E, Santos A, McGinn EE, Ajiboye A, Town N, Lip GYH. Supermarket/Hypermarket Opportunistic Screening for Atrial Fibrillation (SHOPS-AF): A Mixed Methods Feasibility Study Protocol. J Pers Med 2022; 12:jpm12040578. [PMID: 35455694 PMCID: PMC9025049 DOI: 10.3390/jpm12040578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
Aims: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a key risk factor for ischaemic stroke. Following AF detection, treatment with oral anticoagulation can significantly lower mortality and morbidity rates associated with this risk. The availability of several hand-held devices which can detect AF may enable trained health professionals to adopt AF screening approaches which do not interfere with people’s daily routines. This study aims to investigate the effectiveness of a hand-held device (the MyDiagnostick single-lead Electrocardiogram (ECG) sensor) in screening for AF when embedded into the handles of supermarket trolleys. Methods: A mixed methods two-phase approach will be taken. The quantitative first phase will involve the recruitment of 2000 participants from a convenience sample at four large supermarkets with pharmacies. Prospective participants will be asked to conduct their shopping using a trolley embedded with a MyDiagnostick sensor. If the device identifies a participant with AF, the in-store pharmacist will be dispatched to take a manual pulse measurement and a static control sensor reading and offer a cardiologist consultation referral. When the sensor does not detect AF, a researcher will confirm the reading with a manual pulse measurement. ECGs will be compiled, and the sensitivity, specificity and positive and negative predictive values will be determined. A qualitative second phase will consist of semi-structured interviews carried out with those pharmacists and store managers in-store during the running of the trial period. These will explore the perceptions of staff regarding the merits of embedding sensors in the handles of supermarket trolleys to detect AF. Conclusion: This feasibility study will inform a larger future definitive trial.
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Affiliation(s)
- Ian D. Jones
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- Correspondence:
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7 8TX, UK
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Robyn R. Lotto
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - David Oxborough
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- School of Sport and Exercise Science, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh EH11 4DN, UK;
| | - Peter E. Penson
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Gabriela Czanner
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool L3 3AF, UK
| | - Andy Shaw
- School of Civil Engineering and Built Environment, Liverpool John Moores University, Liverpool L3 3AF, UK;
| | - Emma Johnston Smith
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
| | - Aimeris Santos
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - Emily E. McGinn
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - Aderonke Ajiboye
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - Nicola Town
- School of Nursing and Allied Health, Faculty of Health, Liverpool John Moores University, Liverpool L3 2AJ, UK; (R.R.L.); (E.J.S.); (A.S.); (E.E.M.); (A.A.); (N.T.)
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool L3 2AJ, UK; (D.A.L.); (D.O.); (P.E.P.); (G.C.); (G.Y.H.L.)
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool L7 8TX, UK
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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21
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Lawin D, Albrecht UV, Oftring ZS, Lawrenz T, Stellbrink C, Kuhn S. [Mobile health for detection of atrial fibrillation-Status quo and perspectives]. Internist (Berl) 2022; 63:274-280. [PMID: 35147711 PMCID: PMC8832086 DOI: 10.1007/s00108-022-01267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/24/2022]
Abstract
Mobile health (mHealth) for the detection of atrial fibrillation is an innovative domestic monitoring of the heart rhythm. The use of mHealth in the context of atrial fibrillation increases the availability of diagnostic technologies and facilitates the integration into telemedical treatment concepts as well as the active participation of patients in the treatment process. The detection of atrial fibrillation with mHealth applications is usually based on electrocardiography (ECG) or by detection of the pulse wave using photoplethysmography (PPG). Some applications require additional sensors, others make use of sensors integrated into smartphones or smartwatches. A high diagnostic accuracy for the detection of atrial fibrillation has been shown for most mHealth applications regardless of the underlying technology (analytical validation); however, the evidence on positive care effects and improvement of medical endpoints (clinical validation) is so far scarce. Screening of symptomatic or asymptomatic patients and the follow-up care after antiarrhythmic measures are possibilities for the integration into the reality of care. The preventive detection of atrial fibrillation is an attractive field of application for mHealth with great potential for the future. Nevertheless, at present mHealth is only integrated to a limited extent into the reality of patient care. Adequate reimbursement and medical remuneration as well as opportunities to derive information and qualification are prerequisites in order to be able to guarantee a comprehensive implementation in the future. The Digital Health Care Act passed in 2019, regulates the reimbursement of digital healthcare applications but issues of primary preventive applications have not yet been included.
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Affiliation(s)
- Dennis Lawin
- Arbeitsgruppe für Digitale Medizin, Medizinische Fakultät OWL der Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland.
- Klinik für Kardiologie und internistische Intensivmedizin, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Teutoburger Straße 50, 33604, Bielefeld, Deutschland.
| | - Urs-Vito Albrecht
- Arbeitsgruppe für Digitale Medizin, Medizinische Fakultät OWL der Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland
| | - Zoe Sophie Oftring
- Arbeitsgruppe für Digitale Medizin, Medizinische Fakultät OWL der Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland
| | - Thorsten Lawrenz
- Klinik für Kardiologie und internistische Intensivmedizin, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Teutoburger Straße 50, 33604, Bielefeld, Deutschland
| | - Christoph Stellbrink
- Klinik für Kardiologie und internistische Intensivmedizin, Universitätsklinikum OWL der Universität Bielefeld, Campus Klinikum Bielefeld, Teutoburger Straße 50, 33604, Bielefeld, Deutschland
| | - Sebastian Kuhn
- Arbeitsgruppe für Digitale Medizin, Medizinische Fakultät OWL der Universität Bielefeld, Universitätsstraße 25, 33615, Bielefeld, Deutschland
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22
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Papaccioli G, Bassi G, Lugi C, Parente E, D'Andrea A, Proietti R, Imbalzano E, Alturki A, Russo V. Smartphone and new tools for Atrial Fibrillation diagnosis: evidence for clinical applicability. Minerva Cardiol Angiol 2022; 70:616-627. [PMID: 35212504 DOI: 10.23736/s2724-5683.22.05841-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia in adults. AF increases the risk of heart failure, cardiac ischemic disease, dementia and Alzheimer's disease. Either clinical and subclinical AF increase the risk of stroke and worsen the patients' clinical outcome. The early diagnosis of AF episodes, even if asymptomatic or clinically silent, is of pivotal importance to ensure prompt and adequate thromboembolic risk prevention therapies. The development of technology is allowing new systematic mass screening possibilities, especially in patients with higher stroke risk. The mobile health devices available for AF detection are: smartphones, wristworn, earlobe sensors and handheld ECG. These devices showed a high accuracy in AF detection especially when a combined approach with single-Lead ECG and photoplethysmography algorithms is used. The use of wearable devices for AF screening is a feasible method but more head-to-head comparisons between mHealth and medical devices are needed to establish their comparative effectiveness across different study populations.
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Affiliation(s)
- Giovanni Papaccioli
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Bassi
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Cecilia Lugi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Erika Parente
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Riccardo Proietti
- Liverpool center for cardiovascular science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University Hospital of Messina G. Martino, University of Messina, Messina, Italy
| | - Ahmed Alturki
- Division of Cardiology, McGill University Health Center, Montreal, Canada
| | - Vincenzo Russo
- Department of Medical Translational Sciences, Monaldi Hospital, University of Campania Luigi Vanvitelli, Naples, Italy -
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23
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Chan N, Orchard J, Agbayani M, Boddington D, Chao T, Johar S, John B, Joung B, Krishinan S, Krittayaphong R, Kurokawa S, Lau C, Lim TW, Linh PT, Long VH, Naik A, Okumura Y, Sasano T, Yan B, Raharjo SB, Hanafy DA, Yuniadi Y, Nwe N, Awan ZA, Huang H, Freedman B. 2021 Asia Pacific Heart Rhythm Society (APHRS) practice guidance on atrial fibrillation screening. J Arrhythm 2022; 38:31-49. [PMID: 35222749 PMCID: PMC8851593 DOI: 10.1002/joa3.12669] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/11/2021] [Accepted: 12/15/2021] [Indexed: 12/19/2022] Open
Abstract
In this paper, the Asia Pacific Heart Rhythm Society (APHRS) sought to provide practice guidance on AF screening based on recent evidence, with specific considerations relevant to the Asia-Pacific region. A key recommendation is opportunistic screening for people aged ≥65 years (all countries), with systematic screening to be considered for people aged ≥75 years or who have additional risk factors (all countries).
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Affiliation(s)
- Ngai‐Yin Chan
- Princess Margaret HospitalHong Kong Special Administrative RegionChina
| | - Jessica Orchard
- Agnes Ginges Centre for Molecular CardiologyCentenary InstituteSydneyAustralia
- Charles Perkins CentreThe University of SydneySydneyAustralia
| | - Michael‐Joseph Agbayani
- Division of ElectrophysiologyPhilippine Heart CenterManilaPhilippines
- Division of Cardiovascular MedicinePhilippine General HospitalManilaPhilippines
| | | | - Tze‐Fan Chao
- Division of CardiologyDepartment of MedicineTaipei Veterans General HospitalTaipeiTaiwan
- Institute of Clinical Medicine, and Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Sofian Johar
- Consultant CardiologistHead of CardiologyRIPAS HospitalBandar Seri BegawanBrunei Darussalam
- Consultant Cardiac ElectrophysiologistHead of Cardiac ElectrophysiologyGleneagles JPMCJerudongBrunei Darussalam
- Institute of Health SciencesUniversiti Brunei DarussalamJalan Tungku Link GadongBrunei Darussalam
| | - Bobby John
- Cardiology UnitTownsville University HospitalTownsvilleAustralia
- James Cook UniversityTownsvilleAustralia
| | - Boyoung Joung
- Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
| | | | - Rungroj Krittayaphong
- Division of CardiologyDepartment of MedicineSiriraj HospitalMahidol UniversityBangkokThailand
| | - Sayaka Kurokawa
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Chu‐Pak Lau
- Department of MedicineQueen Mary HospitalThe University of Hong KongHong Kong Special Administrative RegionChina
| | - Toon Wei Lim
- National University HospitalNational University Heart CentreSingapore
| | | | | | - Ajay Naik
- Division of CardiologyCare Institute of Medical Sciences HospitalAhmedabadIndia
| | - Yasuo Okumura
- Division of CardiologyDepartment of MedicineNihon University School of MedicineTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Bernard Yan
- Melbourne Brain CentreUniversity of MelbourneMelbourneAustralia
| | - Sunu Budhi Raharjo
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Indonesia, and National Cardiovascular Center Harapan KitaJakartaIndonesia
| | - Dicky Armein Hanafy
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Indonesia, and National Cardiovascular Center Harapan KitaJakartaIndonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular MedicineFaculty of MedicineUniversitas Indonesia, and National Cardiovascular Center Harapan KitaJakartaIndonesia
| | - Nwe Nwe
- Department of CardiologyYangon General HospitalUniversity of MedicineYangonMyanmar
| | | | - He Huang
- Wuhan University Renmin HospitalWuhanChina
| | - Ben Freedman
- Charles Perkins CentreThe University of SydneySydneyAustralia
- Heart Research InstituteCharles Perkins CentreUniversity of SydneySydneyAustralia
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24
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Polidori MC, Alves M, Bahat G, Boureau AS, Ozkok S, Pfister R, Pilotto A, Veronese N, Bo M. Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines. Eur Geriatr Med 2022; 13:5-18. [PMID: 34727362 PMCID: PMC8562074 DOI: 10.1007/s41999-021-00537-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/03/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Task Force for the diagnosis and management of atrial fibrillation (AF) of the European Society of Cardiology (ESC) published in 2020 the updated Guidelines for the Diagnosis and Management of Atrial Fibrillation with the contribution of the European Heart Rhythm Association (EHRA) of the ESC and the European Association for Cardiothoracic Surgery (EACTS). METHODS AND RESULTS In this narrative viewpoint, we approach AF from the perspective of aging medicine and try to provide the readers with information usually neglected in clinical routine, mainly due to the fact that while the large majority of AF patients in real life are older, frail and cognitively impaired, these are mostly excluded from clinical trials, and physicians' attitudes often prevail over standardized algorithms. CONCLUSIONS On the basis of existing evidence, (1) opportunistic AF screening by pulse palpation or ECG rhythm strip is cost-effective, and (2) whereas advanced chronological age by itself is not a contraindication to AF treatment, a Comprehensive Geriatric Assessment (CGA) including frailty, cognitive impairment, falls and bleeding risk may assist in clinical decision making to provide the best individualized treatment.
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Affiliation(s)
- M Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Cologne Excellence Cluster On Cellular Stress-Responses in Aging-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | - Mariana Alves
- Serviço de Medicina III, Hospital Pulido Valente, CHULN, Lisbon, Portugal
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Gulistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Anne Sophie Boureau
- Department of Geriatrics, CHU Nantes and Université de Nantes, CNRS, INSERM, l'Institut du Thorax, 44000, Nantes, France
| | - Serdar Ozkok
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Capa, 34390, Istanbul, Turkey
| | - Roman Pfister
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
- Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Turin, A.O.U. Città della Salute e della Scienza, Molinette, Corso Bramante 88, 10126, Turin, Italy
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Baman JR, Passman RS. The Future of Long‐Term Monitoring After Catheter and Surgical Ablation for Atrial Fibrillation. J Cardiovasc Electrophysiol 2022; 33:1911-1918. [DOI: 10.1111/jce.15375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Jayson R. Baman
- Division of Cardiology, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Rod S. Passman
- Division of Cardiology, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Northwestern University Feinberg School of MedicineChicagoIL
- Center for Arrhythmia Research, Northwestern University Feinberg School of MedicineChicagoIL
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Abstract
PURPOSE OF REVIEW Atrial fibrillation is the most common sustained rhythm abnormality and is associated with stroke, heart failure, cognitive decline, and premature death. Digital health technologies using consumer-grade mobile technologies (i.e. mHealth) capable of recording heart rate and rhythm can now reliably detect atrial fibrillation using single lead or multilead ECG or photoplethysmography (PPG). This review will discuss how these developments are being used to detect and manage atrial fibrillation. RECENT FINDINGS Studies have established the accuracy of mHealth devices for atrial fibrillation detection. The feasibility of using mHealth technology to screen for atrial fibrillation has also been established, though the utility of screening is controversial. In addition to screening, key aspects of atrial fibrillation management can also be performed remotely and effectively using mHealth, though with some important limitations. SUMMARY mHealth technologies have proven disruptive in the diagnosis and management of atrial fibrillation. Healthcare providers can leverage these advances to better care for their atrial fibrillation patients whenever necessary.
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Baman JR, Mathew DT, Jiang M, Passman RS. Mobile Health for Arrhythmia Diagnosis and Management. J Gen Intern Med 2022; 37:188-197. [PMID: 34282532 PMCID: PMC8288067 DOI: 10.1007/s11606-021-07007-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/25/2021] [Indexed: 01/04/2023]
Abstract
Palpitations are a common symptom managed by general practitioners and cardiologists; atrial fibrillation (AF) is the most common arrhythmia in adults. The recent commercial availability of smartphone-based devices and wearable technologies with arrhythmia detection capabilities has revolutionized the diagnosis and management of these common medical issues, as it has placed the power of arrhythmia detection into the hands of the patient. Numerous mobile health (mHealth) devices that can detect, record, and automatically interpret irregularities in heart rhythm and abrupt changes in heart rate using photoplethysmography (PPG)- and electrocardiogram-based technologies are now commercially available. As opposed to prescription-based external rhythm monitoring approaches, these devices are more inexpensive and allow for longer-term monitoring, thus increasing sensitivity for arrhythmia detection, particularly for patients with infrequent symptoms possibly due to cardiac arrhythmias. These devices can be used to correlate symptoms with cardiac arrhythmias, assess efficacy and toxicities of arrhythmia therapies, and screen the population for serious rhythm disturbances such as AF. Although several devices have received clearance for AF detection from the United States Food & Drug Administration, limitations include the need for ECG confirmation for arrhythmias detected by PPG alone, false positives, false negatives, charging requirements for the battery, and financial cost. In summary, the growth of commercially available devices for remote, patient-facing rhythm monitoring represents an exciting new opportunity in the care of patients with palpitations and known or suspected dysrhythmias. Physicians should be familiar with the evidence that underlies their added value to patient care and, importantly, their current limitations.
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Affiliation(s)
- Jayson R Baman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Daniel T Mathew
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Jiang
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rod S Passman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Screening for paroxysmal atrial fibrillation in primary care using Holter monitoring and intermittent, ambulatory single-lead electrocardiography. Int J Cardiol 2021; 345:41-46. [PMID: 34687805 DOI: 10.1016/j.ijcard.2021.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Timely detection of atrial fibrillation (AF) is important because of its increased risk of thrombo-embolic events. Single time point screening interventions fall short in detection of paroxysmal AF, which requires prolonged electrocardiographic monitoring, usually using a Holter. However, traditional 24-48 h Holter monitoring is less appropriate for screening purposes because of its low diagnostic yield. Intermittent, ambulatory screening using a single-lead electrocardiogram (1 L-ECG) device can offer a more efficient alternative. METHODS Primary care patients of ≥65 years participated in an opportunistic screening study for AF. We invited patients with a negative 12 L-ECG to wear a Holter monitor for two weeks and to use a MyDiagnostick 1 L-ECG device thrice daily. We report the yield of paroxysmal AF found by Holter monitoring and calculate the diagnostic accuracy of the 1 L-ECG device's built-in AF detection algorithm with the Holter monitor as reference standard. RESULTS We included 270 patients, of whom four had AF in a median of 8.0 days of Holter monitoring, a diagnostic yield of 1.5% (95%-CI: 0.4-3.8%). In 205 patients we performed simultaneous 1 L-ECG screening. For diagnosing AF based on the 1 L-ECG device's AF detection algorithm, sensitivity was 66.7% (95%-CI: 9.4-99.2%), specificity 68.8% (95%-CI: 61.9-75.1%), positive predictive value 3.1% (95%-CI: 1.4-6.8%) and negative predictive value 99.3% (95%-CI: 96.6-99.9%). CONCLUSION We found a low diagnostic yield of paroxysmal AF using Holter monitoring in elderly primary care patients with a negative 12 L-ECG. The diagnostic accuracy of an intermittently, ambulatory used MyDiagnostick 1 L-ECG device as interpreted by its built-in AF detection algorithm is limited.
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Screening for Atrial Fibrillation in Sub-Saharan Africa: A Health Economic Evaluation to Assess the Feasibility in Nigeria. Glob Heart 2021; 16:80. [PMID: 34900571 PMCID: PMC8641527 DOI: 10.5334/gh.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Cardiovascular disease reflects a major burden of non-communicable disease in Sub-Saharan Africa (SSA). Early detection and treatment of atrial fibrillation (AF), as a preventive measure against stroke, is currently not in the scope of the World Health Organization recommendation to reduce cardiovascular disease. Objective: We hypothesized that screening for AF would be an important approach to determine the true AF prevalence in the general population in African countries and to identify asymptomatic AF patients at risk for stroke to optimize prevention. Methods: A decision analytic model was developed to study the health-economic impact of AF screening in Nigeria over a life-time horizon. The patient population explored in the model was a population of newly detected AF cases that would be diagnosed with a one-time systematic screening for AF with a single lead ECG device in community health centres across Nigeria. Conclusions: The health gain per newly detected AF patient (N = 31,687) was 0.41 QALY at a cost of $5,205 per patient with 100% NOAC use, leading to an ICER of $12,587 per QALY gained. The intervention was cost-effective with a 99.9% warfarin use with an ICER of $1,363 per QALY gained. The total cost of a single screening session was $7.3 million for the total screened population in Nigeria or $1.60 per patient screened. Screening for AF to detect AF patients in need for stroke prevention can be a cost-effective intervention in the Sub-Saharan region, depending on type of anticoagulant used and drug costs.
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Sattar Y, Song D, Sarvepalli D, Zaidi SR, Ullah W, Arshad J, Mir T, Zghouzi M, Elgendy IY, Qureshi W, Chalfoun N, Alraies MC. Accuracy of pulsatile photoplethysmography applications or handheld devices vs. 12-lead ECG for atrial fibrillation screening: a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 65:33-44. [PMID: 34775555 DOI: 10.1007/s10840-021-01068-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The relative accuracy of pulsatile photoplethysmography applications (PPG) or handheld (HH) devices compared with the gold standard 12-lead electrocardiogram (ECG) for the diagnosis of atrial fibrillation is unknown. METHODS Digital databases were searched to identify relevant articles. Raw data were pooled using a bivariate model to calculate diagnostic accuracy measures and estimate Hierarchical Summary Receiver Operating Characteristic (HSROC). RESULTS A total of 10 articles comprising 4296 patients (mean age 68.9 years, with 56% males) were included in the analysis. Compared with EKG, the pooled sensitivity of PPG and HH devices in AF detection was 0.93 (95% CI 0.87-0.96; p < 0.05) and 0.87 (95% CI. 0.74-0.94; p < 0.05), respectively. The pooled specificity of PPG and HH devices in AF detection was 0.91 (95% CI 0.88-0.94; p < 0.05) and 0.96 (95% CI 0.90-0.98; p < 0.05), respectively. The diagnostic odds ratio was 129 and 144 for PPG and HH devices, respectively. Fagan's nomogram showed the probability of a patient having AF and normal rhythm on PPG or HH devices was 2-3%, while the post-test probability of having AF with an irregular R-R interval on PPG or HH devices was 73% and 82%, respectively. The scatter plot of positive and negative likelihood ratio showed high confirmation of AF and reliability of exclusion of absence of irregular R-R intervals (positive likelihood ratio > 10, and negative likelihood ratio < 0.1) on HH devices while PPG was used as confirmation only. CONCLUSIONS The PPG or HH devices can serve as a reliable alternative for the detection of AF.
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Affiliation(s)
- Yasar Sattar
- Cardiology, West Virginia University, Morgantown, WV, USA
| | - David Song
- Cardiology, West Virginia University, Morgantown, WV, USA
| | | | | | - Waqas Ullah
- Cardiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Junaid Arshad
- Internal Medicine, Institute of Medical Sciences, Islamabad, Pakistan
| | - Tanveer Mir
- Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA
| | - Mohamed Zghouzi
- Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA
| | | | - Waqas Qureshi
- Cardiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nagib Chalfoun
- Cardiology, Spectrum Health Heart and Vascular, Michigan State University, Grand Rapids, MI, USA
| | - MChadi Alraies
- Cardiology, Detroit Medical Center Heart Hospital, 311 Mack Ave, Detroit, MI, 48201, USA.
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Beers L, van Adrichem LP, Himmelreich JCL, Karregat EPM, de Jong JSSG, Postema PG, de Groot JR, Lucassen WAM, Harskamp RE. Manual QT interval measurement with a smartphone-operated single-lead ECG versus 12-lead ECG: a within-patient diagnostic validation study in primary care. BMJ Open 2021; 11:e055072. [PMID: 34732504 PMCID: PMC8572408 DOI: 10.1136/bmjopen-2021-055072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/20/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine the accuracy of QT measurement in a smartphone-operated, single-lead ECG (1L-ECG) device (AliveCor KardiaMobile 1L). DESIGN Cross-sectional, within-patient diagnostic validation study. SETTING/PARTICIPANTS Patients underwent a 12-lead ECG (12L-ECG) for any non-acute indication in primary care, April 2017-July 2018. INTERVENTION Simultaneous recording of 1L-ECGs and 12L-ECGs with blinded manual QT assessment. OUTCOMES OF INTEREST: (1) Difference in QT interval in milliseconds (ms) between the devices; (2) measurement agreement between the devices (excellent agreement <20 ms and clinically acceptable agreement <40 ms absolute difference); (3) sensitivity and specificity for detection of extreme QTc (short (≤340 ms) or long (≥480 ms)), on 1L-ECGs versus 12L-ECGs as reference standard. In case of significant discrepancy between lead I/II of 12L-ECGs and 1L-ECGs, we developed a correction tool by adding the difference between QT measurements of 12L-ECG and 1L-ECGs. RESULTS 250 ECGs of 125 patients were included. The mean QTc interval, using Bazett's formula (QTcB), was 393±25 ms (mean±SD) in 1L-ECGs and 392±27 ms in lead I of 12L-ECGs, a mean difference of 1±21 ms, which was not statistically different (paired t-test (p=0.51) and Bland Altman method (p=0.23)). In terms of agreement between 1L-ECGs and lead I, QTcB had excellent agreement in 66.9% and clinically acceptable agreement in 93.4% of observations. The sensitivity and specificity of detecting extreme QTc were 0% and 99.2%, respectively. The comparison of 1L-ECG QTcB with lead II of 12L-ECGs showed a significant difference (p=<0.01), but when using a correction factor (+9 ms) this difference was cancelled (paired t-test (p=0.43) or Bland Altman test (p=0.57)). Moreover, it led to improved rates of excellent (71.3%) and clinically acceptable (94.3%) agreement. CONCLUSION Smartphone-operated 1L-ECGs can be used to accurately measure the QTc interval compared with simultaneously obtained 12L-ECGs in a primary care population. This may provide an opportunity for monitoring the effects of potential QTc-prolonging medications.
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Affiliation(s)
- Lisa Beers
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisa P van Adrichem
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jelle C L Himmelreich
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert P M Karregat
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jonas S S G de Jong
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, Noord-Holland, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC - University of Amsterdam, Amsterdam, The Netherlands
| | - Wim A M Lucassen
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- General Practice, Amsterdam UMC Locatie Meibergdreef, Amsterdam, North Holland, The Netherlands
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Beerten SG, Proesmans T, Vaes B. The effect of a case-finding app on the detection rate of atrial fibrillation compared with opportunistic screening in primary care patients: protocol for a cluster randomized trial. Trials 2021; 22:525. [PMID: 34372905 PMCID: PMC8351454 DOI: 10.1186/s13063-021-05497-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Atrial fibrillation is a cardiac arrhythmia commonly encountered in a primary care setting. Current screening is limited to pulse palpation and ECG confirmation when an irregular pulse is found. Paroxysmal atrial fibrillation will, however, still be difficult to pick up. With the advent of smartphones, screening could be more cost-efficient by making use of simple applications, lowering the need for intensive screening to discover (paroxysmal) atrial fibrillation. Methods/design This cluster randomized trial will examine the effect of using a smartphone-based application such as FibriCheck® on the detection rate of atrial fibrillation in a Flemish general practice population. This study will be conducted in 22 primary care practices across the Flanders region of Belgium and will last 12 months. Patients above 65 years of age will be divided in control and intervention groups on the practice level. The control group will be subjected to standard opportunistic screening only, while the intervention group will be prescribed the FibriCheck® app on top of this opportunistic screening. The difference in detection rate between control and intervention groups will be calculated at the end of the study. We will use the online platform INTEGO for pseudonymized data collection and analysis, and risk calculation. Discussion Smartphone applications might offer a way to cost-effectively screen for (paroxysmal) atrial fibrillation in a primary care setting. This could open the door for the update of future screening guidelines. Trial registration ClinicalTrials.gov NCT04545723. Registered on September 10, 2020.
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Affiliation(s)
| | | | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Halvaei H, Svennberg E, Sörnmo L, Stridh M. Identification of Transient Noise to Reduce False Detections in Screening for Atrial Fibrillation. Front Physiol 2021; 12:672875. [PMID: 34149452 PMCID: PMC8212862 DOI: 10.3389/fphys.2021.672875] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Screening for atrial fibrillation (AF) with a handheld device for recording the ECG is becoming increasingly popular. The poorer signal quality of such ECGs may lead to false detection of AF, often caused by transient noise. Consequently, the need for expert review in AF screening can become extensive. A convolutional neural network (CNN) is proposed for transient noise identification in AF detection. The network is trained using the events produced by a QRS detector, classified into either true beat detections or false detections. The CNN and a low-complexity AF detector are trained and tested using the StrokeStop I database, containing 30-s ECGs from mass screening for AF in the elderly population. Performance evaluation of the CNN-based quality control using a subset of the database resulted in sensitivity, specificity, and accuracy of 96.4, 96.9, and 96.9%, respectively. By inserting the CNN before the AF detector, the false AF detections were reduced by 22.5% without any loss in sensitivity. The results show that the number of recordings calling for expert review can be significantly reduced thanks to the identification of transient noise. The reduction of false AF detections is directly linked to the time and cost spent on expert review.
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Affiliation(s)
- Hesam Halvaei
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Emma Svennberg
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Leif Sörnmo
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Martin Stridh
- Department of Biomedical Engineering, Lund University, Lund, Sweden
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. J Arrhythm 2021; 37:271-319. [PMID: 33850572 PMCID: PMC8022003 DOI: 10.1002/joa3.12461] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de TelessaúdeHospital das Clínicasand Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queensand School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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35
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. Ann Noninvasive Electrocardiol 2021; 26:e12795. [PMID: 33513268 PMCID: PMC7935104 DOI: 10.1111/anec.12795] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | | | - Yufeng Hu
- Taipei Veterans General HospitalTaipeiTaiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of RochesterRochesterNYUSA
| | - Rod Passman
- Northwestern University Feinberg School of MedicineChicagoILUSA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de MedicinaCentro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | | | - David Slotwiner
- Cardiology DivisionNewYork‐Presbyterian Queens, and School of Health Policy and ResearchWeill Cornell MedicineNew YorkNYUSA
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Varma N, Cygankiewicz I, Turakhia M, Heidbuchel H, Hu Y, Chen LY, Couderc J, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini J, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE / HRS / EHRA / APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:7-48. [PMID: 36711170 PMCID: PMC9708018 DOI: 10.1093/ehjdh/ztab001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology / Heart Rhythm Society / European Heart Rhythm Association / Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Affiliation(s)
| | | | | | - Hein Heidbuchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - Yufeng Hu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of Rochester, Rochester, NY, USA
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - David Slotwiner
- Cardiology Division, NewYork-Presbyterian Queens, and School of Health, Policy and Research, Weill Cornell Medicine, New York, NY, USA
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Boriani G, Palmisano P, Malavasi VL, Fantecchi E, Vitolo M, Bonini N, Imberti JF, Valenti AC, Schnabel RB, Freedman B. Clinical Factors Associated with Atrial Fibrillation Detection on Single-Time Point Screening Using a Hand-Held Single-Lead ECG Device. J Clin Med 2021; 10:729. [PMID: 33673209 PMCID: PMC7917757 DOI: 10.3390/jcm10040729] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 02/07/2023] Open
Abstract
Our aim was to assess the prevalence of unknown atrial fibrillation (AF) among adults during single-time point rhythm screening performed during meetings or social recreational activities organized by patient groups or volunteers. A total of 2814 subjects (median age 68 years) underwent AF screening by a handheld single-lead ECG device (MyDiagnostick). Overall, 56 subjects (2.0%) were diagnosed with AF, as a result of 12-lead ECG following a positive/suspected recording. Screening identified AF in 2.9% of the subjects ≥ 65 years. None of the 265 subjects aged below 50 years was found positive at AF screening. Risk stratification for unknown AF based on a CHA2DS2VASc > 0 in males and >1 in females (or CHA2DS2VA > 0) had a high sensitivity (98.2%) and a high negative predictive value (99.8%) for AF detection. A slightly lower sensitivity (96.4%) was achieved by using age ≥ 65 years as a risk stratifier. Conversely, raising the threshold at ≥75 years showed a low sensitivity. Within the subset of subjects aged ≥ 65 a CHA2DS2VASc > 1 in males and >2 in females, or a CHA2DS2VA > 1 had a high sensitivity (94.4%) and negative predictive value (99.3%), while age ≥ 75 was associated with a marked drop in sensitivity for AF detection.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy; (V.L.M.); (E.F.); (M.V.); (N.B.); (J.F.I.); (A.C.V.)
| | - Pietro Palmisano
- Cardiology Unit, “Card. G. Panico” Hospital, 73039 Tricase, Italy;
| | - Vincenzo Livio Malavasi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy; (V.L.M.); (E.F.); (M.V.); (N.B.); (J.F.I.); (A.C.V.)
| | - Elisa Fantecchi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy; (V.L.M.); (E.F.); (M.V.); (N.B.); (J.F.I.); (A.C.V.)
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy; (V.L.M.); (E.F.); (M.V.); (N.B.); (J.F.I.); (A.C.V.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Niccolo’ Bonini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy; (V.L.M.); (E.F.); (M.V.); (N.B.); (J.F.I.); (A.C.V.)
| | - Jacopo F. Imberti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy; (V.L.M.); (E.F.); (M.V.); (N.B.); (J.F.I.); (A.C.V.)
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy; (V.L.M.); (E.F.); (M.V.); (N.B.); (J.F.I.); (A.C.V.)
| | - Renate B. Schnabel
- German Cardiovascular Research Center (DZHK), Partner Site Hamburg/Kiel/Lübeck, University Heart and Vascular Centre, 20251 Hamburg, Germany;
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, and Concord Hospital Cardiology, University of Sydney, Sydney 2006, Australia;
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Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu YF, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini JP, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society. Circ Arrhythm Electrophysiol 2021; 14:e009204. [PMID: 33573393 PMCID: PMC7892205 DOI: 10.1161/circep.120.009204] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society describes the current status of mobile health technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mobile health. The promises of predictive analytics but also operational challenges in embedding mobile health into routine clinical care are explored.
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Affiliation(s)
- Niraj Varma
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | | | | | | | - Yu-Feng Hu
- Taipei Veterans General Hospital, Taiwan (Y.-F.H.)
| | | | | | | | | | | | | | - Reena Mehra
- Cleveland Clinic, OH (N.V., J.D.E., R.M., R.E.R.)
| | - Alex Page
- University of Rochester, NY (J.-P.C., A.P., J.S.S.)
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL (R. Passman)
| | | | - Ewa Piotrowicz
- National Institute of Cardiology, Warsaw, Poland (E.P., R. Piotrowicz)
| | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (A.L.R.)
| | | | - Andrea M. Russo
- Cooper Medical School of Rowan University, Camden, NJ (A.M.R.)
| | - David Slotwiner
- Cardiology Division, New York-Presbyterian Queens, NY (D.S.)
| | | | - Emma Svennberg
- Karolinska University Hospital, Stockholm, Sweden (E.S.)
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Varma N, Cygankiewicz I, Turakhia MP, Heidbuchel H, Hu Y, Chen LY, Couderc JP, Cronin EM, Estep JD, Grieten L, Lane DA, Mehra R, Page A, Passman R, Piccini JP, Piotrowicz E, Piotrowicz R, Platonov PG, Ribeiro AL, Rich RE, Russo AM, Slotwiner D, Steinberg JS, Svennberg E. 2021 ISHNE/HRS/EHRA/APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:4-54. [PMID: 35265889 PMCID: PMC8890358 DOI: 10.1016/j.cvdhj.2020.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.
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Key Words
- ACC, American College of Cardiology
- ACS, acute coronary syndrome
- AED, automated external defibrillator
- AF, atrial fibrillation
- AHA, American Heart Association
- AHRE, atrial high-rate episode
- AI, artificial intelligence
- APHRS, Asia Pacific Heart Rhythm Society
- BP, blood pressure
- CIED, cardiovascular implantable electronic device
- CPR, cardiopulmonary resuscitation
- EHR A, European Heart Rhythm Association
- EMR, electronic medical record
- ESUS, embolic stroke of unknown source
- FDA (U.S.), Food and Drug Administration
- GPS, global positioning system
- HCP, healthcare professional
- HF, heart failure
- HR, heart rate
- HRS, Heart Rhythm Society
- ICD, implantable cardioverter-defibrillator
- ILR, implantable loop recorder
- ISHNE, International Society for Holter and Noninvasive Electrocardiology
- JITAI, just-in-time adaptive intervention
- MCT, mobile cardiac telemetry
- OAC, oral anticoagulant
- PAC, premature atrial complex
- PPG, photoplethysmography
- PVC, premature ventricular complexes
- SCA, sudden cardiac arrest
- TADA, Technology Assissted Dietary Assessment
- VT, ventricular tachycardia
- arrhythmias
- atrial fibrillation
- comorbidities
- digital medicine
- heart rhythm
- mHealth
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Affiliation(s)
| | | | | | - Hein Heidbuchel
- Antwerp University and University Hospital, Antwerp, Belgium
| | - Yufeng Hu
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | | | | - Alex Page
- University of Rochester, Rochester, NY, USA
| | - Rod Passman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Antonio Luiz Ribeiro
- Faculdade de Medicina, Centro de Telessaúde, Hospital das Clínicas, and Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - David Slotwiner
- Cardiology Division, NewYork-Presbyterian Queens, and School of Health Policy and Research, Weill Cornell Medicine, New York, NY, USA
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Zink MD, Mischke KG, Keszei AP, Rummey C, Freedman B, Neumann G, Tolksdorf A, Frank F, Wienströer J, Kuth N, Schulz JB, Marx N. Screen-detected atrial fibrillation predicts mortality in elderly subjects. Europace 2021; 23:29-38. [PMID: 33020819 PMCID: PMC7842093 DOI: 10.1093/europace/euaa190] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/18/2020] [Indexed: 01/05/2023] Open
Abstract
AIMS Current guidelines recommend opportunistic screening for atrial fibrillation (AF) but the prognosis of individuals is unclear. The aim of this investigation is to determine prevalence and 1-year outcome of individuals with screen-detected AF. METHODS AND RESULTS We performed a prospective, pharmacy-based single time point AF screening study in 7107 elderly citizens (≥65 years) using a hand-held, single-lead electrocardiogram (ECG) device. Prevalence of AF was assessed, and data on all-cause death and hospitalization for cardiovascular (CV) causes were collected over a median follow-up of 401 (372; 435) days. Mean age of participants was 74 ± 5.9 years, with 58% (N = 4130) of female sex. Automated heart rhythm analyses identified AF in 432 (6.1%) participants, with newly diagnosed AF in 3.6% of all subjects. During follow-up, 62 participants (0.9%) died and 390 (6.0%) were hospitalized for CV causes. Total mortality was 2.3% in participants with a screen-detected AF and 0.8% in subjects with a normal ECG [hazard ratio (HR) 2.94; 95% confidence interval (CI) 1.49-5.78; P = 0.002]; hospitalization for CV causes occurred in 10.6% and 5.5%, respectively (HR 2.08; 95% CI 1.52-2.84; P < 0.001). Compared with subjects without a history of AF at baseline and a normal ECG, participants with newly diagnosed or known AF had a significantly higher mortality risk with HRs of 2.64 (95% CI 1.05-6.66; P = 0.04) and 2.68 (95% CI 1.44-4.97; P = 0.002), respectively. After multivariable adjustment, screen-detected AF remained a significant predictor of death or hospitalization for CV causes. CONCLUSION Pharmacy-based, automated AF screening in elderly citizens identified subjects with unknown AF and an excess mortality risk over the next year.
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Affiliation(s)
- Matthias D Zink
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, D-52074 Aachen, Germany
- Cardiovascular Research Institute Maastricht (CARIM), Department of Physiology, Maastricht, the Netherlands
| | - Karl G Mischke
- Department of Internal Medicine I, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Andras P Keszei
- Center for Translational and Clinical Research, RWTH Aachen University, Aachen, Germany
| | | | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, Concord Hospital Cardiology, University of Sydney, Camperdown, Australia
| | | | - Alina Tolksdorf
- Department of General Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Friederike Frank
- Department of General Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jan Wienströer
- Department of Medical Informatics, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Nicole Kuth
- Department of General Medicine, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Jörg B Schulz
- Department of Neurology, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
- JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, D-52074 Aachen, Germany
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Benjamin EJ, Go AS, Desvigne-Nickens P, Anderson CD, Casadei B, Chen LY, Crijns HJ, Freedman B, Hills MT, Healey JS, Kamel H, Kim DY, Link MS, Lopes RD, Lubitz SA, McManus DD, Noseworthy PA, Perez MV, Piccini JP, Schnabel RB, Singer DE, Tieleman R, Turakhia MP, Van Gelder IC, Cooper LS, Al-Khatib SM. Research Priorities in Atrial Fibrillation Screening: A Report From a National Heart, Lung, and Blood Institute Virtual Workshop. Circulation 2021; 143:372-388. [PMID: 33493033 PMCID: PMC8776506 DOI: 10.1161/circulationaha.120.047633] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Clinically recognized atrial fibrillation (AF) is associated with higher risk of complications, including ischemic stroke, cognitive decline, heart failure, myocardial infarction, and death. It is increasingly recognized that AF frequently is undetected until complications such as stroke or heart failure occur. Hence, the public and clinicians have an intense interest in detecting AF earlier. However, the most appropriate strategies to detect undiagnosed AF (sometimes referred to as subclinical AF) and the prognostic and therapeutic implications of AF detected by screening are uncertain. Our report summarizes the National Heart, Lung, and Blood Institute's virtual workshop focused on identifying key research priorities related to AF screening. Global experts reviewed major knowledge gaps and identified critical research priorities in the following areas: (1) role of opportunistic screening; (2) AF as a risk factor, risk marker, or both; (3) relationship between AF burden detected with long-term monitoring and outcomes/treatments; (4) designs of potential randomized trials of systematic AF screening with clinically relevant outcomes; and (5) role of AF screening after ischemic stroke. Our report aims to inform and catalyze AF screening research that will advance innovative, resource-efficient, and clinically relevant studies in diverse populations to improve the diagnosis, management, and prognosis of patients with undiagnosed AF.
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Affiliation(s)
- Emelia J. Benjamin
- Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, and Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118 (E.J.B.)
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612. Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA 94143. Departments of Medicine, Health Research and Policy, Stanford University, Stanford, CA 94305 (A.S.G.)
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 (P.D.N., L.S.C.)
| | - Christopher D. Anderson
- Department of Neurology, Center for Genomic Medicine, and McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA 02114 (C.D.A.)
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX39DU, UK (B.C.)
| | - Lin Y. Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN 55455 (L.Y.C.)
| | - Harry J.G.M. Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands (H.J.G.M.C.)
| | - Ben Freedman
- Heart Research Institute, Charles Perkins Centre, and Concord Hospital Department of Cardiology, Concord Clinical School, University of Sydney, Sydney, Australia (B.F.)
| | - Mellanie True Hills
- StopAfib.org, American Foundation for Women’s Health, Decatur, TX 76234 (M.T.H.)
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada (J.S.H.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY 10021 (H.K.)
| | - Dong-Yun Kim
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 (D.Y.K.)
| | - Mark S. Link
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX 75390 (M.S.L.)
| | - Renato D. Lopes
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 27710 (R.D.L., J.P.P., S.M.A.)
| | - Steven A. Lubitz
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA (S.A.L.)
| | - David D. McManus
- Department of Medicine, Division of Cardiology, University of MA Medical School, Worcester, MA 01655 (D.D.M.)
| | - Peter A. Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902 (P.A.N.)
| | - Marco V. Perez
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA 95125 (M.V.P.)
| | - Jonathan P. Piccini
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 27710 (R.D.L., J.P.P., S.M.A.)
| | - Renate B. Schnabel
- Department of Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck (R.B.S.)
| | - Daniel E. Singer
- Division of General Internal Medicine, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, 02114 (D.E.S.)
| | - Robert Tieleman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (I.C.V.G, R.T.)
- Department of Cardiology, Martini Hospital, Groningen, The Netherlands (R.T.)
| | - Mintu P. Turakhia
- Veterans Affairs Palo Alto Health Care System, Palo Alto CA; Center for Digital Health, Stanford University, Stanford, CA (M.P.T.)
| | - Isabelle C. Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands (I.C.V.G, R.T.)
| | - Lawton S. Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892 (P.D.N., L.S.C.)
| | - Sana M. Al-Khatib
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, 27710 (R.D.L., J.P.P., S.M.A.)
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Magnusson P, Lyren A, Mattsson G. Patient-reported feasibility of chest and thumb ECG after cryptogenic stroke in Sweden: an observational study. BMJ Open 2020; 10:e037360. [PMID: 33115891 PMCID: PMC7594353 DOI: 10.1136/bmjopen-2020-037360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the feasibility, based on a questionnaire, of the chest and thumb ECG system Coala Heart Monitor in patients who recently had a stroke. DESIGN Observational study. SETTING Two stroke units, Region Gävleborg, Sweden. PARTICIPANTS AND INTERVENTIONS This study, Transient ECG Assessment in Stroke Evaluation (TEASE), included patients who had a stroke between 2017 and 2019. Patients eligible for anticoagulation in the presence of atrial fibrillation were scheduled for 28 days monitoring. PRIMARY AND SECONDARY OUTCOME MEASURES The questionnaire regarding feasibility of monitoring included seven questions, using a 100 mm Visual Analogue Scale which covered overall satisfaction, technical feasibility, remember to monitor, physical application, feeling of security, help from others and recommendation to others. A lower score indicated better outcome. RESULTS The prespecified number of 100 patients underwent the monitoring and 83 out of the 97 alive patients returned the questionnaire (response rate 85.6%). The median age was 69.5 years, mean CHA2DS2-VASc score was 4.4±1.3 points and 59.0% were men (n=49). The median time from index stroke to start of monitoring was 7.0 days. Patients performed on average 90.1%±15.0% of scheduled ECG-transmissions. In all seven questions, the median score ranged from 4 to 8. The vast majority reported acceptable outcomes, that is, the 95th percentile ranged from 30 to 54. There was no significant difference between men and women with regard to any of the seven questions (p values ranging from 0.117 to 0.849). Two of the seven outcome scores correlated significantly to patient age (Spearman's r=-0.238 and r=-0.308, and p values 0.031 and 0.005 for 'overall satisfaction' and 'remember to monitor', respectively). CONCLUSION In stroke survivors, chest and thumb ECG two times per day over a period of 4 weeks is feasible from a patient's perspective. The Coala Heart Monitor provides a valuable and convenient tool for monitoring after stroke. TRIAL REGISTRATION NUMBER NCT03301662.
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Affiliation(s)
- Peter Magnusson
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
- Institution of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Adam Lyren
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Gustav Mattsson
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
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Zink MD, Napp A, Gramlich M. Experience in screening for atrial fibrillation and monitoring arrhythmia using a single-lead ECG stick. Herzschrittmacherther Elektrophysiol 2020; 31:246-253. [PMID: 32785743 DOI: 10.1007/s00399-020-00711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia and is highly associated with increased morbidity and mortality. Since many AF episodes remain subclinical, screening for AF is considered a desirable approach for timely diagnosis, prevention of sequelae and effective treatment. Recently, devices for AF detection-stand-alone or integrated in mobile health technology-have become available and show promising preliminary results in the detection and monitoring of arrhythmia. This review describes the technical aspects of a single-lead ECG stick and summarizes the current literature, experience in large-scale screening for AF in pharmacies and potential fields of application.
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Affiliation(s)
- Matthias Daniel Zink
- Department of Internal Medicine I-Cardiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52078, Aachen, Germany. .,Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
| | - Andreas Napp
- Department of Internal Medicine I-Cardiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52078, Aachen, Germany
| | - Michael Gramlich
- Department of Internal Medicine I-Cardiology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52078, Aachen, Germany
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Rivezzi F, Vio R, Bilato C, Pagliani L, Pasquetto G, Saccà S, Verlato R, Migliore F, Iliceto S, Bossone V, Bertaglia E. Screening of unknown atrial fibrillation through handheld device in the elderly. J Geriatr Cardiol 2020; 17:495-501. [PMID: 32952524 PMCID: PMC7475215 DOI: 10.11909/j.issn.1671-5411.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of unknown atrial fibrillation (AF) in the elderly population of the Veneto Region, Italy. METHODS 1820 patients aged ≥ 65 years with no history of AF and not anticoagulated were enrolled in primary-care settings. They underwent an opportunistic electrocardiogram screening with a handheld device (MyDiagnostick) designed to specifically detect AF. The electrocardiogram recordings were reviewed by the researchers, who confirmed the presence of AF. RESULTS The device detected an arrhythmia in 143 patients, which was confirmed as AF in 101/143 (70.6%), with an overall prevalence of AF of 5.5% (101/1820). Prevalence of unknown AF resulted in 3.6% in patients aged 65-74 years, and 7.5% in patients age 75 or older, and increased according to CHA2DS2-VASc score: 3.5% in patients with a score of 1 or 2, 5.6% in patients with a score of 3, 7.0% in patients with a score of 4, and 7.2% in patients with a score ≥ 5. The detection rate was significantly higher in patients with mild symptoms compared to asymptomatic counterparts (24.1% vs. 4.0%, P < 0.0001). At multivariate analysis, congestive heart failure and age ≥ 75 years-old were independent predictors for screen-detected AF. CONCLUSIONS An opportunistic screening with handheld device revealed an unexpectedly high prevalence of unknown AF in elderly patients with mild symptoms. Prevalence increased with age and CHA2DS2-VASc score.
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Affiliation(s)
- Francesco Rivezzi
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Riccardo Vio
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza General Hospitals, Arzignano, Vicenza, Italy
| | | | - Giampaolo Pasquetto
- Division of Cardiology, "Riuniti Hospitals Padova Sud", Monselice, Padova, Italy
| | - Salvatore Saccà
- Department of Cardiology, General Hospital, Mirano, Venezia, Italy
| | - Roberto Verlato
- Division of Cardiology, Pietro Cosma Hospital, Camposampiero, Padova, Italy
| | - Federico Migliore
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Emanuele Bertaglia
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Emanuele Bertaglia, MD, PhD, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Padova, Italy. E-mail:
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Kułach A, Dewerenda M, Majewski M, Lasek-Bal A, Gąsior Z. 72 hour Holter monitoring, 7 day Holter monitoring, and 30 day intermittent patient-activated heart rhythm recording in detecting arrhythmias in cryptogenic stroke patients free from arrhythmia in a screening 24 h Holter. Open Med (Wars) 2020; 15:697-701. [PMID: 33336026 PMCID: PMC7712313 DOI: 10.1515/med-2020-0203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/12/2020] [Accepted: 06/01/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction According to recent studies, silent atrial fibrillation (AF) is a common cause of cryptogenic ischemic stroke (CIS). 12-lead electrocardiogram (ECG) and 24 h Holter are not efficient to reveal an occult arrhythmic cause of stroke. Objectives The aim of the study was to evaluate 72 h Holter, 7 day Holter monitoring, and intermittent single-lead ECG recording in patients with CIS to identify cases with the arrhythmic cause of stroke in patients with CIS in whom 24 h ECG Holter was free from arrhythmia. Methods 72 patients (aged 60 ± 9 years, 44 males) with CIS and no arrhythmic findings in 24 h Holter were enrolled. All patients had 7 day Holter monitoring and received handheld ECG recorder (CheckMe, Viatom) for ambulatory 30 ± 3 days ECG recording. AF, supraventricular tachycardia (SVT runs of ≥5 QRS), and other arrhythmias were assessed in the first 72 h of Holter recording, in 7 day-recording, and in handheld ECG strips. Results 72 h-recording revealed AF in four cases (5.6%) and SVT in 18 (25%) cases. 7 day Holter confirmed AF in seven patients (10%) and SVT in 27 patients (37.5%). There was no difference in regards to CHADS2VASc score between patients with SVT and non-arrhythmic group (3.6 ± 1.1 vs 3.4 ± 1.6; p = NS). Symptoms did not correlate with findings. Patient-activated handheld ECG recorders were used with good compliance. The mean number of recordings was 49 ± 30. Except for PACs, there was only one case of AF documented in 3,531 strips. Conclusions 7 day Holter performs better than 72 h and reveals supraventricular arrhythmias in every third and AF in 10% of CIS patients who were free from arrhythmia in 24 h ECG monitoring. 30 day intermittent ECG monitor does not yield diagnostic value in CIS.
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Affiliation(s)
- Andrzej Kułach
- Department of Cardiology, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland
| | - Milena Dewerenda
- Department of Neurology, Upper-Silesian Medical Center, Katowice, Poland
| | - Michał Majewski
- Department of Cardiology, Upper-Silesian Medical Center, Katowice, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Gąsior
- Department of Cardiology, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland
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Abstract
Atrial fibrillation (AF) is a major cause of morbidity and mortality globally, and much of this is driven by challenges in its timely diagnosis and treatment. Existing and emerging mobile technologies have been used to successfully identify AF in a variety of clinical and community settings, and while these technologies offer great promise for revolutionizing AF detection and screening, several major barriers may impede their effectiveness. The unclear clinical significance of device-detected AF, potential challenges in integrating patient-generated data into existing healthcare systems and clinical workflows, harm resulting from potential false positives, and identifying the appropriate scope of population-based screening efforts are all potential concerns that warrant further investigation. It is crucial for stakeholders such as healthcare providers, researchers, funding agencies, insurers, and engineers to actively work together in fulfilling the tremendous potential of mobile technologies to improve AF identification and management on a population level.
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Affiliation(s)
- Eric Y Ding
- From the Department of Population and Quantitative Health Sciences and Division of Cardiology, Department of Medicine, University of Massachusetts Medical School (E.Y.D., D.D.M.)
| | - Gregory M Marcus
- Division of Cardiology, Department of Medicine, University of California, San Francisco (G.M.M.)
| | - David D McManus
- From the Department of Population and Quantitative Health Sciences and Division of Cardiology, Department of Medicine, University of Massachusetts Medical School (E.Y.D., D.D.M.)
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Siontis KC, Yao X, Pirruccello JP, Philippakis AA, Noseworthy PA. How Will Machine Learning Inform the Clinical Care of Atrial Fibrillation? Circ Res 2020; 127:155-169. [DOI: 10.1161/circresaha.120.316401] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Machine learning applications in cardiology have rapidly evolved in the past decade. With the availability of machine learning tools coupled with vast data sources, the management of atrial fibrillation (AF), a common chronic disease with significant associated morbidity and socioeconomic impact, is undergoing a knowledge and practice transformation in the increasingly complex healthcare environment. Among other advances, deep-learning machine learning methods, including convolutional neural networks, have enabled the development of AF screening pathways using the ubiquitous 12-lead ECG to detect asymptomatic paroxysmal AF in at-risk populations (such as those with cryptogenic stroke), the refinement of AF and stroke prediction schemes through comprehensive digital phenotyping using structured and unstructured data abstraction from the electronic health record or wearable monitoring technologies, and the optimization of treatment strategies, ranging from stroke prophylaxis to monitoring of antiarrhythmic drug (AAD) therapy. Although the clinical and population-wide impact of these tools continues to be elucidated, such transformative progress does not come without challenges, such as the concerns about adopting black box technologies, assessing input data quality for training such models, and the risk of perpetuating rather than alleviating health disparities. This review critically appraises the advances of machine learning related to the care of AF thus far, their potential future directions, and its potential limitations and challenges.
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Affiliation(s)
| | - Xiaoxi Yao
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery (X.Y.), Mayo Clinic, Rochester, MN
- Division of Health Care Policy and Research, Department of Health Sciences Research (X.Y.), Mayo Clinic, Rochester, MN
| | - James P. Pirruccello
- Broad Institute, Cambridge, MA (J.P.P., A.A.P.)
- Division of Cardiology, Massachusetts General Hospital, Boston (J.P.P.)
| | | | - Peter A. Noseworthy
- From the Department of Cardiovascular Medicine (K.C.S., P.A.N.), Mayo Clinic, Rochester, MN
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Opportunistic screening versus usual care for diagnosing atrial fibrillation in general practice: a cluster randomised controlled trial. Br J Gen Pract 2020; 70:e427-e433. [PMID: 31988084 DOI: 10.3399/bjgp20x708161] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/07/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) increases the risk of stroke, heart failure, and all-cause mortality. AF may be asymptomatic and therefore remain undiagnosed. Devices such as single-lead electrocardiographs (ECGs) may help GPs to diagnose AF. AIM To investigate the yield of opportunistic screening for AF in usual primary care using a single-lead ECG device. DESIGN AND SETTING A clustered, randomised controlled trial among patients aged ≥65 years with no recorded AF status in the Netherlands from October 2014 to March 2016. METHOD Fifteen intervention general practices used a single-lead ECG device at their discretion and 16 control practices offered usual care. The follow-up period was 1 year, and the primary outcome was the proportion of newly diagnosed cases of AF. RESULTS In total, 17 107 older people with no recorded AF status were eligible to participate in the study. In the intervention arm, 10.7% of eligible patients (n = 919) were screened over the duration of the study year. The rate of newly diagnosed AF was similar in the intervention and control practices (1.43% versus 1.37%, P = 0.73). Screened patients were more likely to have comorbidities, such as hypertension (60.0% versus 48.7%), type 2 diabetes (24.3% versus 18.6%), and chronic obstructive pulmonary disease (11.3% versus 7.4%), than eligible patients not screened in the intervention arm. Among patients with newly diagnosed AF in intervention practices, 27% were detected by screening, 23% by usual primary care, and 50% by a medical specialist or after stroke/transient ischaemic attack. CONCLUSION Opportunistic screening with a single-lead ECG at the discretion of the GP did not result in a higher yield of newly detected cases of AF in patients aged ≥65 years in the community than usual care. For higher participation rates in future studies, more rigorous screening methods are needed.
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Diagnostic accuracy of handheld electrocardiogram devices in detecting atrial fibrillation in adults in community versus hospital settings: a systematic review and meta-analysis. Heart 2020; 106:1211-1217. [DOI: 10.1136/heartjnl-2020-316611] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/20/2020] [Accepted: 03/29/2020] [Indexed: 02/06/2023] Open
Abstract
With increasing use of handheld ECG devices for atrial fibrillation (AF) screening, it is important to understand their accuracy in community and hospital settings and how it differs among settings and other factors. A systematic review of eligible studies from community or hospital settings reporting the diagnostic accuracy of handheld ECG devices (ie, devices producing a rhythm strip) in detecting AF in adults, compared with a gold standard 12-lead ECG or Holter monitor, was performed. Bivariate hierarchical random-effects meta-analysis and meta-regression were performed using R V.3.6.0. The search identified 858 articles, of which 14 were included. Six studies recruited from community (n=6064 ECGs) and eight studies from hospital (n=2116 ECGs) settings. The pooled sensitivity was 89% (95% CI 81% to 94%) in the community and 92% (95% CI 83% to 97%) in the hospital. The pooled specificity was 99% (95% CI 98% to 99%) in the community and 95% (95% CI 90% to 98%) in the hospital. Accuracy of ECG devices varied: sensitivity ranged from 54.5% to 100% and specificity ranged from 61.9% to 100%. Meta-regression showed that setting (p=0.032) and ECG device type (p=0.022) significantly contributed to variations in sensitivity and specificity. The pooled sensitivity and specificity of single-lead handheld ECG devices were high. Setting and handheld ECG device type were significant factors of variation in sensitivity and specificity. These findings suggest that the setting including user training and handheld ECG device type should be carefully reviewed.
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Opportunistic screening for atrial fibrillation with a single lead device in geriatric patients. J Geriatr Cardiol 2020; 17:149-154. [PMID: 32280331 PMCID: PMC7118016 DOI: 10.11909/j.issn.1671-5411.2020.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the diagnostic yield of repeated screening for atrial fibrillation (AF) among geriatric patients. METHODS A pragmatic prospective cohort study into applying opportunistic screening for AF with a handheld single lead ECG device (SLD) in a geriatric cohort. Consecutive patients of 65 years old and older visiting the geriatric outpatient clinic were eligible for inclusion. A 12 lead ECG was performed, followed by measurements with the SLD during every visit to the geriatric outpatient clinic. A frailty index was based on the accumulation of deficits model. RESULTS 478 patients were eligible. Patients were excluded if they did not give informed consent (17 patients), had a pacemaker or implantable cardioverter defibrillator (20 patients), or had incomplete medical files (two patients). After exclusion, 439 patients participated in this study. The mean age was 78 years (range 65 to 100 years), 54% were female. AF was known in 89 patients (20%), first detected on the baseline ECG in four patients (1%) and first detected with the SLD in 20 patients (5%) during follow up visits. Sensitivity of the SLD was 90.0%, specificity 99.0%, negative predictive value 99.7%, and positive predictive value 73.5%. Most patients (82%) with AF were frail and 53% were severely frail. CONCLUSION Repeated screening in geriatric patients has a five times higher diagnostic yield than usual care. It was easily combined with usual care. Because of the positive predictive value of 73.5%, it remains necessary to confirm AF with a 12 lead ECG or 24-h Holter monitoring.
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