Wearable electrocardiogram (ECG) solutions can help screen older individuals for atrial fibrillation (AFib), according to a new analysis published in JAMA Cardiology. The study’s authors see this as an effective strategy for reducing strokes.
“Approximately 10% to 20% of ischemic strokes are attributed to previously undiagnosed AFib, and AFib-associated strokes tend to be more disabling and more often fatal compared with other types of ischemic strokes,” wrote lead author David J. Gladstone, MD, PhD, of the department of medicine at the University of Toronto, and colleagues. “If screening can effectively detect sufficient numbers of individuals with AF and trigger initiation of oral anticoagulant therapy (OAC), many strokes could potentially be prevented.”
Gladstone et al. conducted a randomized trial of more than 800 hypertension patients. All participants were 75 or older and did not have known AFib. They were enrolled at 48 different facilities from April 2015 to March 2019.
While the study’s control group received standard care, including routine evaluations, the screening group received standard care in addition to wearing two-week continuous ECG monitors at the start of the trial and after three months. To provide another layer of data, participants in the screening group were also given automated blood pressure machines to take home and use twice daily during the ECG monitoring periods.
Overall, the wearable solutions helped identify AFib in 5.3% of the screening group. In the control group, standard care helped healthcare providers identify AFib in just 0.5% of participants.
Among patients from the screening group with confirmed AFib, the median total time spent in AFib was 6.2 hours. The median duration of the longest AFib episode was 5.7 hours. Also, OAC was initiated in 75% of patients of those patients.
Also, for 1.2% of patients in the screening group, “adverse skin reactions” caused the ECG monitoring to end earlier than planned.
In addition, the authors wrote, using the automated blood pressure machines from home twice daily had a sensitivity of 35%, specificity of 81%, positive predictive value of 8.9% and negative predictive value of 95.9%.
“This randomized clinical trial provides evidence that a wearable continuous ECG strategy is well tolerated and effective for early detection of AFib in older primary care patients, often leading to OAC treatment with the potential to avert future strokes,” the authors wrote. “Intermittent oscillometric screening with a BP monitor is an inferior strategy for detecting paroxysmal AF. Future studies need to determine the effect of AF screening on clinical outcomes.”
Read the full study here.