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AF detection: untargeted
| Title | Year | Objective | Key Message(s) |
|---|---|---|---|
| Smartphone-Based Screening for Atrial Fibrillation – Experiences from Bosnia and Herzegovina |
2022 | To examine the prevalence of AF and the effectiveness of photoplethysmography (PPG) deriving smartphone app in Bosnia and Herzegovina. | The use of smartphone-based technologies for the detection of AF has proven to be an effective way of screening the population for this heart rhythm, as all patients with a positive result based on the 7-day screening were confirmed via the 24-hour Holter ECG. Although this is a small pilot study, the results indicate that the number of patients with AF is higher in relation to available statistical data and date from everyday medical practice. Therefore, it is necessary to develop a good strategy for early AF screening to prevent adverse outcomes such as stroke but also other cardiovascular complications. |
| Atrial fibrillation screening with photo-plethysmography through a smartphone camera | 2019 | Small studies on PPG-based screening for AF have already demonstrated excellent sensitivity of 100%with an acceptable specificity of 90–97% against the 12-lead ECG as gold standard. The current study was set up to assess the feasibility of mass screening for AF through a smartphone-based algorithm using PPG technology by the only CE approved application that has been recently developed |
Data from this study strongly suggest that more intensive screening for AF is associated with a substantially higher diagnostic yield. |
AF detection in high risk patients: around stroke
| Title | Year | Objective | Key Messages |
|---|---|---|---|
| The Potential and Limitations of Mobile Health and Insertable Cardiac Monitors in the Detection of Atrial Fibrillation in Cryptogenic Stroke Patients: Preliminary Results From the REMOTE Trial | 2022 | To explore the opportunities and hurdles of using insertable cardiac monitors and PPG-based mHealth using a smartphone or smartwatch to detect AF in cryptogenic stroke and transient ischemic attack patients. | mHealth was able to detect AF in a patient in which AF was confirmed on the ICM Even state-of-the-art ICMs yielded many false-positive AF registrations Both mHealth and ICM still require physician revision Blinding of the mHealth results impairs compliance and motivation. |
| Will Smartphone Applications Replace the Insertable Cardiac Monitor in the Detection of Atrial Fibrillation? The First Comparison in a Case Report of a Cryptogenic Stroke Patient | 2022 | To investigates the added value of PPG-based mobile health in AF detection using spot-check and semi-continuous measurements on the smartphone or smartwatch, respectively. | First report of the cryptogenic stroke patient in whom PPG-based mHealth was able to detect occurrence and burden of paroxysmal AF episodes with similar precision as ICM. ICM is the most performant rhythm monitoring device but is expensive, invasive, and currently underutilized. This case demonstrated the feasibility of implementing PPG-based mHealth monitoring as a low-cost and non-invasive tool. |
| The use of a photoplethymography- deriving smartphone app to screen for atrial fibrillation in primary stroke prevention during the covid pandemic | 2021 | The aim of this study is to assess the use of a PPG-deriving smartphone-app for early detection of AF and initiation of appropriate treatment to prevent AF-related complications, like stroke. | PPG-deriving technologies enable remote AF-detection and may contribute to timely initiation of appropriate treatments to prevent complications. One of the major advantages of this approach is the fact that physicians are able to remotely screen and follow-up at risk without the need for face-to-face contacts. |
| Health economic assessment of smartphone implementation for atrial fibrillation monitoring in cryptogenic stroke patients | 2020 | To address long-term cost-effectiveness of prolonged monitoring by implementing a smartphone application for AF monitoring in post-cryptogenic stroke patients and assessing its cost-effectiveness. | After a cryptogenic stroke, 3-month FibriCheck monitoring proved to be cost-effective for preventing recurrent strokes. These results strengthen the evidence base for prolonged monitoring in secondary stroke prevention. The implementation of FibriCheck in a population of 1000 patients resulted in 26 quality adjusted life years (QALY) and substantial cost savings of -1.189 €/QALY |
| Implementation of a pulse deriving smartphone application in high risk populations for primary and secondary prevention of stroke | 2019 | This multi centre national study addresses the implementation and evaluation of a pulsederiving smartphone application in highrisk patient populations as a solution for primary and secondary stroke prevention. The study was performed for the Cabinet of Minister of Health De Block and the National Institute for Health and Disability Insurance (RIZIV). | This study presents the first results of prolonged PPG monitoring in high risk populations for AF detection. Considering the high number of asymptomatic registrations, repeated PPG spotchecks proved to be valuable for the detection of new or recurrent, (a)symptomatic, paroxysmal or persistent AF. |
AF detection in high risk patients: increased risk score
| Title | Year | Objective | Key Messages |
|---|---|---|---|
| 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 | 2021 | Implementing the FibriCheck app in a primary care setting could solve the problem of screening for AF and, specifically, detecting PAF. the aim of this study is to investigate the effect of a case-finding strategy with the FibriCheck application on the detection rate of AF in comparison with opportunistic screening (i.e. pulse palpation, followed by an ECG) in patients with ahigh risk of AF in general practice. The secondary objective is to keep track of thrombo-embolic complications, death and compliance with measurements. | This will be the first study to evaluate the influence of a stand-alone smartphone application on the detection rate of AF compared to a control group. The availability of correctly coded data is essential for the study to be conducted. Physicians must code diligently and completely. To screen high-risk patients, we will use the sufficiently validated CHARGE-AF score. A screening period of 4 weeks will provide sufficient diagnostic yield. Possible limitations to the study are a sufficient working internet connection and patient compliance. |
| Self-Reported Mobile Health-Based Risk Factor and CHA2DS2-VASc-Score Assessment in Patients With Atrial Fibrillation: TeleCheck-AF Results | 2022 | To evaluate the feasibility and accuracy of a remote mobile app-based self-reported assessment of AF risk factors and CHA2DS2-VASc-score, with the help of a 10-item questionnaire | Collection of AF-risk factors by an app-based 10-item questionnaire is feasible, even despite the age of participants. High accuracy of pacemaker and anticoagulation treatment assessment, Limited accuracy for the assessment of some of the traditional AF risk factors as components of the CHA2DS2-VASc-score. Whether app-based risk factor assessment can be incorporated in personalized patient education and longitudinal guidance of risk factor modification programs requires future studies. |
| Evaluation of the feasibility and accuracy of remote mobile app-based self-reported atrial fibrillation risk factor assessment in patients with atrial fibrillation: TeleCheck-AF results | 2021 | To evaluate the feasibility and accuracy of remote mobile app-based self-reported AF risk factor assessment in AF patients | Patient self-reported AF risk factors by a remote mobile app-based assessment is feasible and may be useful for future digital trials and comprehensive remote AF management through teleconsultation |
AF detection in high risk patients: post-cardiac surgery
| Title | Year | Objective | Key Messages |
|---|---|---|---|
| Remote Heart Rhythm Monitoring by Photoplethysmography-Based Smartphone Technology After Cardiac Surgery - Prospective Observational Study | 2021 | By using a PPG-based smartphone app, we aimed to gain more insight into the prevalence of AF and other rhythm-related complications upon discharge home after cardiac surgery and evaluate the implementation of this app into routine clinical care | Implementation of smartphone-based PPG technology enables detection of AF and other rhythm-related complications after cardiac surgery. An association between AF detection and an underlying complication was found in 2 patients. Smartphone-based PPG technology may supplement rehabilitation after cardiac surgery by acting as a sentinel for underlying complications, rhythm-related or otherwise. |
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