The eHealth-based Bavarian Alternative Detection of Atrial Fibrillation (eBRAVE-AF) trial asked older adult members of one German health insurer to use a smartphone app that measured pulse irregularities using the phone’s camera button and then wear a 14-day electrocardiogram patch in order to engage at-risk patients to seek a doctor’s treatment.
WHY IT MATTERS
Afib is the most common heart rhythm disorder and is often hard to diagnose due to a lack of symptoms.
While previous studies tested the potential of smart devices for large-scale Afib screening, they made no comparison with conventional screening – symptom evaluation, ECGs and other methods – according to the European Society of Cardiology announcement.
The eBRAVE-AF researchers invited adults aged 50 to 90 years old who were at risk for stroke but had not experienced any major adverse cardiac and cerebrovascular events and who owned smartphones to participate.
Participants had no known atrial fibrillation, no oral anticoagulant prescriptions and a CHA2DS2-VASc score (a scoring methodology based on several factors that would increase the risk of stroke) of ≥1 men and ≥2 in women.
The participants had a median age of 65 and were 31% female.
Thirty-eight of the 2,860 participants assigned to smartphone screening and 17 of the 2,691 participating in conventional screening were newly diagnosed with Afib during the study, which led to independent physicians prescribing oral anticoagulation, according to the researchers’ presentation on Aug. 28 at the ESC Congress.
The Jena, Germany-based Preventicus Heartbeats smartphone app, which claims 96% overall accuracy, was used in the study to measure pulse wave irregularities using the patient’s smartphone’s photoplethysmographic sensor, or PPG.
To start a one-minute PPG measurement, participants placed their fingers on the smartphone’s camera. Researchers asked digital screening participants – and sent reminders – to measure PPG twice per day for 14 days, then twice each week.
If PPG results were abnormal, the researchers then sent the participants a patch to record a 14-day ECG and mail it back. Researchers evaluated the ECGs and sent results back to participants to speak with their individual physicians, who made the treatment decisions.
After six months, participants switched study groups.
For the secondary analysis, atrial fibrillation, PPG-detected atrial fibrillation and abnormal PPG findings significantly predicted conditions ripe for stroke, heart failure or other heart problems.
“Screening using common smartphones significantly increased the detection rate of therapy-relevant atrial fibrillation,” professor Axel Bauer of Innsbruck Medical University, Austria, with several affiliations including the LMU University Hospital in Munich, said in a statement.
The study was well-received by the older patients.
THE LARGER TREND
Several studies have turned to digital health devices to study their use in delivering effective cardiovascular care and have encountered issues with engagement – getting patients to follow up on Afib device alerts as well as triggering potentially unnecessary healthcare visits.
In 2020, the seminal Apple Heart Study with more than 420,000 participants (25,000 over age 65) validated Apple Watch’s role in detecting Afib, but researchers struggled with engagement overall.
Once the algorithm running in the background detected an irregularity and pulse consistent with AFib, it would send an alert for the participant to press one button on the Apple Watch to get into a cue for a study visit with a doctor.
About 2,200 participants received such notifications, but only 945 of them followed up with a visit, leading those researchers to ponder how to make a solution that is generalizable.
Then last year, a study published in the Journal of the American Medical Association found that wearing a device could increase the likelihood a patient would undergo an ablation procedure.
Those researchers found no difference in the clinic-measured pulse rates between wearables patients and the control group, just higher healthcare use rates among individuals who used wearables.
ON THE RECORD
“This trial focused on a target population for atrial fibrillation screening, rather than all-comers. We found that digital screening was well received by older participants, who tended to perform even more PPG measurements than younger participants in the study,” Bauer said in the statement.
Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS publication.
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