Consumer-Led Screening for Atrial Fibrillation: A Report From the mAFA-II Trial Long-Term Extension Cohort

Smart watch applications in atrial fibrillation detection: Current state and future directions

INTRODUCTION

Atrial fibrillation (Afib) is a prevalent chronic arrhythmia associated with severe complications, including stroke, heart failure, and increased mortality. This review explores the use of smartwatches for Afib detection, addressing the limitations of current monitoring methods and emphasizing the potential of wearable technology in revolutionizing healthcare.

RESULTS/OBSERVATION

Current Afib detection methods, such as electrocardiography, have limitations in sensitivity and specificity. Smartwatches with advanced sensors offer continuous monitoring, improving the chances of detecting asymptomatic and paroxysmal Afib. The review meticulously examines major clinical trials studying Afib detection using smartwatches, including the landmark Apple Heart Study and ongoing trials such as the Heart Watch, Heartline, and Fitbit Heart Study. Detailed summaries of participant numbers, smartwatch devices used, and key findings are presented. It also comments on the cost-effectiveness and scalability of smartwatch-based screening, highlighting the potential to reduce healthcare costs and improve patient outcomes.

CONCLUSION/RELEVANCE

The integration of wearable technology into healthcare can lead to earlier diagnosis, improved patient engagement, and enhanced cardiac health monitoring. Despite ethical considerations and disparities, the potential benefits outweigh the challenges. This review calls for increased awareness, collaboration with insurance companies, and ongoing research efforts to optimize smartwatch accuracy and encourage widespread adoption of Afib detection. With insights from major trials, this review serves as a comprehensive reference for healthcare professionals and policymakers, guiding future strategies in the early diagnosis and management of atrial fibrillation.

Global voices on atrial fibrillation care in China

An aging population, coupled with the high prevalence of physical inactivity, obesity, dyslipidemia, hypertension, and diabetes mellitus, has led to a significant increase in the incidence and prevalence of atrial fibrillation (AF) in China. Managing clinical complexity of AF patients poses significant challenges. Current guidelines advocate for holistic or integrated management using the ABC (Atrial fibrillation Better Care) pathway. Compliance with the ABC pathway has demonstrated promising benefit in improving clinical outcomes. The mAFA II trial (the mHealth technology for improved screening, patient involvement, and optimized integrated care in Atrial Fibrillation) explores the potential of a mobile health technology-supported integrated care approach in reducing the risks of rehospitalization and clinical adverse events. However, disparities persist between urban and rural areas, with the likelihood of rural older individuals by themselves using intelligent devices being extremely low. Therefore, the application prospects of the mobile AF application strategy in rural areas are greatly limited. The ongoing MIRACLE-AF trial (A Novel Model of Integrated Care of Older Patients With Atrial Fibrillation in Rural China) aims to address unique healthcare challenges faced by rural older patients with AF through a novel integrated care model, which is led by village doctors and supported by a digital health platform. In conclusion, innovative integrated care approaches using digital technologies offer promising solutions to enhance AF care across diverse settings in China, catering to the needs of both urban and rural populations.

2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play

Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.

Smartwatch-based algorithm for early detection of pulmonary infection: Validation and performance evaluation

Background

The proliferation of smart devices provides the possibility of early detection of the signs of pulmonary infections (PI). This study validates a smartwatch-based algorithm to monitor the risk of PI in adults.

Methods

An algorithm that runs on smartwatches was developed and tested in 87 patients with PI and 408 healthy subjects. The algorithm examines heart rate variability, respiratory rate, oxygen saturation, body temperature, and cough sound. It was embedded into the Respiratory Health Study app for a smartwatch to detect the risk of PI and was further validated in the hospital. Doctors diagnosed PI using a clinical evaluation, lab tests, and imaging examination, the gold standard for diagnosis. The accuracy, sensitivity, and specificity of the algorithm predicting PI were evaluated.

Results

In all, 80 patients with PI and 85 healthy volunteers were recruited to validate the accuracy of the algorithm. The area under the curve of the algorithm for predicting PI was 0.86 (95% confidence interval: 0.82-0.91) (P < 0.001). Compared to the gold standard, the overall accuracy of the algorithm was 85.9%, the sensitivity was 81.4%, and the specificity was 90.4%. The algorithm for heart rate, respiratory rate, oxygen saturation, and body temperature had an accuracy of 68.2%, and the accuracy of the algorithm including cough sound was 82.6%.

Conclusion

Our wearable system facilitated the detection of risk of PI. Multi-source features were useful for enhancing the performance of the lung infection screening algorithm.

Trial Registration

Chinese Clinical Trial Registry of the International Clinical Trials Registry Platform of the World Health Organization ChiCTR2100050843; https://www.chictr.org.cn/showproj.html?proj = 126556.

Advances in Clinical Cardiology 2022: A Summary of Key Clinical Trials

INTRODUCTION

Over the course of 2022, numerous key clinical trials with valuable contributions to clinical cardiology were published or presented at major international conferences. This review seeks to summarise these trials and to reflect on their clinical context.

METHODS

The authors reviewed clinical trials presented at major cardiology conferences during 2022, including the American College of Cardiology (ACC), European Association for Percutaneous Cardiovascular Interventions (EuroPCR), European Society of Cardiology (ESC), Transcatheter Cardiovascular Therapeutics (TCT), American Heart Association (AHA), European Heart Rhythm Association (EHRA), Society for Cardiovascular Angiography and Interventions (SCAI), TVT-The Heart Summit (TVT) and Cardiovascular Research Technologies (CRT). Trials with a broad relevance to the cardiology community and those with potential to change current practice were included.

RESULTS

A total of 93 key cardiology clinical trials were identified for inclusion. Interventional cardiology data included trials evaluating the use of new generation novel stent technology and new intravascular physiology strategies such as quantitative flow ratio (QFR) to guide revascularisation in stable and unstable coronary artery disease. New trials in acute coronary syndromes and intervention focused on long-term outcomes of optimal medical therapy (OMT), revascularisation in ischaemic dysfunction and left main (LM) intervention. Structural intervention trials included latest data on optimal timing and anticoagulation strategies in transcatheter aortic valve replacement (TAVR), in addition to expanding evidence in mitral and tricuspid valve interventions. Heart failure data included trials with sodium-glucose cotransporter 2 (SGLT2) inhibitors, iron replacement and novel drugs such as omecamtiv. Prevention trials included new data on proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and polypill strategies. In electrophysiology, new data regarding optimal timing of ablative therapy for atrial fibrillation (AF) in addition to novel screening strategies were evaluated.

CONCLUSION

This article presents a summary of key clinical cardiology trials published and presented during the past year and should be of interest to both practising clinicians and researchers.