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Biweekly mobile ECG screenings show promise for AF detection in older patients
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Biweekly ECG screening via a heart monitor attached to a Wi-Fi-enabled mobile device was three times more likely than routine follow-up with a general practitioner to identify incident atrial fibrillation in ambulatory patients aged at least 65 years with increased risk for stroke, according to results of the REHEARSE-AF study.
The randomized controlled trial was designed to evaluate AF screening using the hand-held smartphone-based heart monitor (Kardia, AliveCor) to obtain ECGs during a 1-year period. The monitor consists of a device and app that enable patients or health care professionals to record and review ECGs. The device attaches to the back of a mobile device, which then communicates wirelessly with the heart monitor app.
In total, 1,001 patients aged 65 years and older were randomly assigned to routine care (n = 501) or to record a 30-second single-lead ECG using the smartphone-based device and transmit it to a secure server twice a week; the traces were then analyzed remotely (n = 500).
The mean age of the patients was 73 years, and slightly more than half were women. All patients had a CHADS-VASc score of at least 2 (mean score, 3) and were free from AF at the start of the trial. Overall, 54% of patients had hypertension, 30% diabetes, 16% arterial disease, 6.5% prior stroke or transient ischemic attack, and 1.4% HF.
Overall, 60,440 ECGs were recorded during 1 year in the smartphone-based device group.
After 1 year, AF was diagnosed in 19 patients in the smartphone-based device group vs. five patients in the routine care group (HR = 3.9; 95% CI, 1.4-10.4). The mean cost per AF diagnosis was $10,780, the researchers reported in Circulation.
Patients in both groups had a similar number of stroke, TIA or systemic embolic events during the 1-year period (HR = 0.61; 95% CI, 0.22-1.69).
“This approach results in an almost fourfold increase in the likelihood of a diagnosis of AF being made over the course of a year and at a cost of $10,780 per additional AF diagnosis,” Julian P.J. Halcox, MD, of the Swansea University Medical School, and colleagues concluded.
In other results, the researchers reported that four of five patients submitted one or more weekly ECGs using the smartphone-based device during 90% of the study period, and two or more weekly ECGs during 75% of the study period.
Patients in the intervention group reported overall satisfaction with the device and ease of use without restricting activities or causing anxiety.
“Our findings suggest that this approach could be considered for AF screening in routine practice, particularly in the highest-risk patients,” Halcox and colleagues wrote. “These results support consideration of evaluation in an appropriately powered, event-driven randomized trial to confirm clinical and cost-effectiveness of such an approach to stroke prevention in AF,” Halcox and colleagues wrote.
The findings were also presented at the European Society of Cardiology Congress. – by Dave Quaile
Disclosure s : The REHEARSE-AF study was funded by the Welsh Government Health Technology and Telehealth Fund and AliveCor Inc. The authors report no relevant financial disclosures.
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