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Linz D, Gawalko M, Betz K, Hendriks JM, Lip GY, Vinter N, Guo Y, Johnsen S. Atrial fibrillation: epidemiology, screening and digital health. Lancet Reg Health Eur 2024; 37:100786. [PMID: 38362546 PMCID: PMC10866942 DOI: 10.1016/j.lanepe.2023.100786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/12/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Atrial fibrillation (AF) is highly prevalent with a lifetime risk of about 1 in 3-5 individuals after the age of 45 years. Between 2010 and 2019, the global prevalence of AF has risen markedly from 33.5 million to 59 million individuals living with AF. Early detection of AF and implementation of appropriate treatment could reduce the frequency of complications associated with AF. International AF management guidelines recommend opportunistic and systematic screening for AF, but additional data are needed. Digital approaches and pathways have been proposed for early detection and for the transition to early AF management. Mobile health (mHealth) devices provide an opportunity for digital screening and should be part of novel models of care delivery based on integrated AF care pathways. For a broad implementation of mHealth-based, integrated care for patients with chronic diseases as AF, further high quality evidence is necessary. In this review, we present an overview of the present data on epidemiology, screening techniques, and the contribution of digital health solutions to the integrated management of AF. We also provide a systemic review on current data of digital and integrated AF management.
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Affiliation(s)
- Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Konstanze Betz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Department of Internal Medicine, Eifelklinik St. Brigida, Simmerath, Germany
| | - Jeroen M. Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Nicklas Vinter
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Yutao Guo
- Six Medical Center, Department of Pulmonary Vessel and Thrombotic Disease, Chinese PLA General Hospital, Beijing, China
| | - Søren Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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van der Velden RMJ, Hereijgers MJM, Arman N, van Middendorp N, Franssen FME, Gawalko M, Verhaert DVM, Habibi Z, Vernooy K, Koltowski L, Hendriks JM, Heidbuchel H, Desteghe L, Simons SO, Linz D. Implementation of a screening and management pathway for chronic obstructive pulmonary disease in patients with atrial fibrillation. Europace 2023; 25:euad193. [PMID: 37421318 PMCID: PMC10351574 DOI: 10.1093/europace/euad193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Chronic obstructive pulmonary disease (COPD) negatively impacts the efficacy of heart rhythm control treatments in patients with atrial fibrillation (AF). Although COPD is recognized as a risk factor for AF, practical guidance about how and when to screen for COPD is not available. Herein, we describe the implementation of an integrated screening and management pathway for COPD into the existing pre-ablation work-up in an AF outpatient clinic infrastructure. METHODS AND RESULTS Consecutive unselected patients accepted for AF catheter ablation in the Maastricht University Medical Center+ were prospectively screened for airflow limitation using handheld (micro)spirometry at the pre-ablation outpatient clinic supervised by an AF nurse. Patients with results suggestive of airflow limitation were offered referral to the pulmonologist. Handheld (micro)spirometry was performed in 232 AF patients, which provided interpretable results in 206 (88.8%) patients. Airflow limitation was observed in 47 patients (20.3%). Out of these 47 patients, 29 (62%) opted for referral to the pulmonologist. The primary reason for non-referral was low perceived symptom burden. Using this screening strategy 17 (out of 232; 7.3%) ultimately received a diagnosis of chronic respiratory disease, either COPD or asthma. CONCLUSION A COPD care pathway can successfully be embedded in an existing AF outpatient clinic infrastructure, using (micro)spirometry and remote analysis of results. Although one out of five patients had results suggestive of an underlying chronic respiratory disease, only 62% of these patients opted for a referral. Pre-selection of patients as well as patient education might increase the diagnostic yield and requires further research.
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Affiliation(s)
- Rachel M J van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Maartje J M Hereijgers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Nazia Arman
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Naomi van Middendorp
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Frits M E Franssen
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 MD Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dominique V M Verhaert
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands
| | - Zarina Habibi
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands
| | - Lukasz Koltowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, 5001 Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5000 Adelaide, Australia
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, 2650 Antwerp, Belgium
- Research Group Cardiovascular Diseases, University of Antwerp, 2650 Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3590 Hasselt, Belgium
| | - Lien Desteghe
- Department of Cardiology, Antwerp University Hospital, 2650 Antwerp, Belgium
- Research Group Cardiovascular Diseases, University of Antwerp, 2650 Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3590 Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Sami O Simons
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 MD Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5000 Adelaide, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Betz K, Verhaert DVM, Gawalko M, Hermans ANL, Habibi Z, Pluymaekers NAHA, van der Velden RMJ, Homberg M, Philippens S, Hereijgers MJM, Vorstermans B, Simons SO, den Uijl DW, Chaldoupi SM, Luermans JGLM, Westra SW, Lankveld T, van Steenwijk RP, Hol B, Schotten U, Vernooy K, Hendriks JM, Linz D. Atrial fibrillation-specific refinement of the STOP-Bang sleep apnoea screening questionnaire: insights from the Virtual-SAFARI study. Clin Res Cardiol 2023; 112:834-845. [PMID: 36773038 PMCID: PMC10241725 DOI: 10.1007/s00392-023-02157-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is prevalent in up to 50% of patients referred for atrial fibrillation (AF) catheter ablation (CA). Currently, it remains unclear how to improve pre-selection for SDB screening in patients with AF. AIM We aimed to (1) assess the accuracy of the STOP-Bang screening questionnaire for detection of SDB within an AF population referred for CA; (2) derive a refined, AF-specific SDB score to improve pre-selection. METHODS Consecutive AF patients referred for CA without a history of SDB and/or SDB screening were included. Patients were digitally referred to the previously implemented Virtual-SAFARI SDB screening and management pathway including a home sleep test. An apnoea-hypopnoea index (AHI) of ≥ 15 was interpreted as moderate-to-severe SDB. Logistic regression analysis was used to assess characteristics associated with moderate-to-severe SDB to refine pre-selection for SDB screening. RESULTS Of 206 included patients, 51% were diagnosed with moderate-to-severe SDB. The STOP-Bang questionnaire performed poorly in detecting SDB, with an area under the receiver operating characteristic curve (AUROC) of 0.647 (95% Confidence-Interval (CI) 0.573-0.721). AF-specific refinement resulted in the BOSS-GAP score. Therein, BMI with cut-off point ≥ 27 kg/m2 and previous stroke or transient ischaemic attack (TIA) were added, while tiredness and neck circumference were removed. The BOSS-GAP score performed better with an AUROC of 0.738 (95% CI 0.672-0.805) in the overall population. CONCLUSION AF-specific refinement of the STOP-Bang questionnaire moderately improved detection of SDB in AF patients referred for CA. Whether questionnaires bring benefits for pre-selection of SDB compared to structural screening in patients with AF requires further studies. TRIAL REGISTRATION NUMBER ISOLATION was registered NCT04342312, 13-04-2020.
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Affiliation(s)
- Konstanze Betz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Internal Medicine, Eifelklinik St. Brigida GmbH & Co. KG, Kammerbruchstraße 8, 52152, Simmerath, Germany
| | - Dominique V M Verhaert
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Monika Gawalko
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- 1St Department of Cardiology, Doctoral School, Medical University of Warsaw, Żwirki i Wigury 61, 02-091, Warsaw, Poland
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Forsthausweg 2, 47057, Duisburg, Germany
| | - Astrid N L Hermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Zarina Habibi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Rachel M J van der Velden
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Marloes Homberg
- Department of Anesthesiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Suzanne Philippens
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Maartje J M Hereijgers
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Bianca Vorstermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sami O Simons
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Dennis W den Uijl
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Sjoerd W Westra
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Theo Lankveld
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | | | - Bernard Hol
- Netherland Sleep Institute, Computerweg 4, 3821 AB, Amersfoort, The Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Port Rd, Adelaide, SA, 5000, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia
| | - Dominik Linz
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
- Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Port Rd, Adelaide, SA, 5000, Australia.
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, Adelaide, SA, 5042, Australia.
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1165, Copenhagen, Denmark.
- Maastricht UMC+, Maastricht Heart+Vascular Center, 6202 AZ, Maastricht, The Netherlands.
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4
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Hermans ANL, Isaksen JL, Gawalko M, Pluymaekers NAHA, van der Velden RMJ, Snippe H, Evens S, De Witte G, Luermans JGLM, Manninger M, Lumens J, Kanters JK, Linz D. Accuracy of continuous photoplethysmography-based 1 min mean heart rate assessment during atrial fibrillation. Europace 2023; 25:835-844. [PMID: 36748247 PMCID: PMC10062358 DOI: 10.1093/europace/euad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/11/2023] [Indexed: 02/08/2023] Open
Abstract
AIMS Although mobile health tools using photoplethysmography (PPG) technology have been validated for the detection of atrial fibrillation (AF), their utility for heart rate assessment during AF remains unclear. Therefore, we aimed to evaluate the accuracy of continuous PPG-based 1 min mean heart rate assessment during AF. METHODS AND RESULTS Persistent AF patients were provided with Holter electrocardiography (ECG) (for ≥24 h) simultaneously with a PPG-equipped smartwatch. Both the PPG-based smartwatch and Holter ECG automatically and continuously monitored patients' heart rate/rhythm. ECG and PPG recordings were synchronized and divided into 1 min segments, from which a PPG-based and an ECG-based average heart rate estimation were extracted. In total, 47 661 simultaneous ECG and PPG 1 min heart rate segments were analysed in 50 patients (34% women, age 73 ± 8 years). The agreement between ECG-determined and PPG-determined 1 min mean heart rate was high [root mean squared error (RMSE): 4.7 bpm]. The 1 min mean heart rate estimated using PPG was accurate within ±10% in 93.7% of the corresponding ECG-derived 1 min mean heart rate segments. PPG-based 1 min mean heart rate estimation was more often accurate during night-time (97%) than day-time (91%, P < 0.001) and during low levels (96%) compared to high levels of motion (92%, P < 0.001). A neural network with a 10 min history of the recording did not further improve the PPG-based 1 min mean heart rate assessment [RMSE: 4.4 (95% confidence interval: 3.5-5.2 bpm)]. Only chronic heart failure was associated with a lower agreement between ECG-derived and PPG-derived 1 min mean heart rates (P = 0.040). CONCLUSION During persistent AF, continuous PPG-based 1 min mean heart rate assessment is feasible in 60% of the analysed period and shows high accuracy compared with Holter ECG for heart rates <110 bpm.
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Affiliation(s)
- Astrid N L Hermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jonas L Isaksen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1165 Copenhagen, Denmark
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Forsthausweg 2, 47057 Duisburg, Germany.,1st Department of Cardiology, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Rachel M J van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Hilco Snippe
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Stijn Evens
- Qompium NV, Kempische Steenweg 293/16, 3500 Hasselt, Belgium
| | - Glenn De Witte
- Qompium NV, Kempische Steenweg 293/16, 3500 Hasselt, Belgium
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerpl. 2, 8036 Graz, Austria
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, The Netherlands
| | - Jørgen K Kanters
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1165 Copenhagen, Denmark
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Nørregade 10, 1165 Copenhagen, Denmark.,Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Port Rd, Adelaide SA 5000, Australia
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Wybraniec M, Mizia-Szubryt M, Gawalko M, Uzieblo-Zyczkowska B, Gorczyca-Glowacka I, Kaufmann D, Wojcik M, Hiczkiewicz J, Fijalkowski M, Szymanska A, Haberka M, Michalski B, Tomaszuk-Kazberuk A, Kozinski M, Mizia-Stec K. Heart failure and the risk of left atrial thrombus formation in patients with atrial fibrillation and atrial flutter: insights from the LATTEE registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The aim of the study was to evaluate the prevalence of left atrial thrombus (LAT) on transesophageal echocardiography (TEE) in patients with atrial fibrillation and atrial flutter (AF/AFl) with reference to the presence of heart failure (HF) and its subtypes.
Methods
The research is a substudy of multicenter, prospective, observational Left Atrial Thrombus on Transesopahgeal Echocardiography (LATTEE) registry, which comprised 3109 consecutive patients with AF/AFl undergoing TEE prior to direct current cardioversion or catheter ablation. TEE parameters, including presence of LAT, were compared between patients with and without HF, as well as different subtypes of HF, including HF with preserved (HFpEF), mid-range (HFmrEF) and reduced ejection fraction (HFrEF).
Results
HF was diagnosed in 1336 patients (43%). HF patients had higher prevalence of LAT than non-HF patients (12.8% vs. 4.4%, P<0.001). The rate of LAT increased with the more advanced type of systolic dysfunction (HFrEF vs. HFmrEF vs. HFpEF: 20.3% vs. 10.5% vs. 7.4%, P<0.001; Figure 1). Univariate analysis revealed that HFrEF (OR 4.13, 95% CI: 3.13–5.46) but not HFmrEF or HFpEF predicted the presence of LAT. Multivariable logistic regression indicated that left ventricular ejection fraction (unit OR=0.94 per 1%, 95% CI: 0.93–0.95) was an independent predictor of LAT formation. Receiver operator characteristic analysis showed LVEF ≤48% predicted presence of LAT (AUC=0.74, P<0.0001).
Conclusion
The diagnosis of HFrEF, but not HFpEF, confers a considerable risk of LAT presence despite widespread utilization of adequate anticoagulation in the assessed population. TEE should be considered in these patients prior to cardioversion or catheter ablation despite adequate oral anticoagulation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Wybraniec
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology , Katowice , Poland
| | - M Mizia-Szubryt
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology , Katowice , Poland
| | - M Gawalko
- Medical University of Warsaw, 1st Department of Cardiology , Warsaw , Poland
| | - B Uzieblo-Zyczkowska
- Military Institute of Medicine, Department of Cardiology and Internal Diseases , Warsaw , Poland
| | - I Gorczyca-Glowacka
- Swietokrzyskie Cardiology Center, 1st Clinic of Cardiology and Electrotherapy , Kielce , Poland
| | - D Kaufmann
- Medical University of Gdansk, Department of Cardiology and Electrotherapy , Gdansk , Poland
| | - M Wojcik
- Medical University of Lublin, Department of Cardiology , Lublin , Poland
| | - J Hiczkiewicz
- University Hospital in Zielona Gora, Collegium Medicum , Zielona Gora , Poland
| | - M Fijalkowski
- Medical University of Gdansk, 1st Department of Cardiology , Gdansk , Poland
| | - A Szymanska
- The Medical Centre of Postgraduate Education, Department of Heart Diseases , Warsaw , Poland
| | - M Haberka
- School of Health Sciences, Medical University of Silesia, Department of Cardiology , Katowice , Poland
| | - B Michalski
- Medical University of Lodz, Department of Cardiology , Lodz , Poland
| | - A Tomaszuk-Kazberuk
- Medical University of Bialystok, Department of Cardiology , Bialystok , Poland
| | - M Kozinski
- Medical University of Gdansk, Department of Cardiology and Internal Medicine , Gdansk , Poland
| | - K Mizia-Stec
- School of Medicine in Katowice, Medical University of Silesia, First Department of Cardiology , Katowice , Poland
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6
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van der Velden RM, Hermans AN, Pluymaekers NA, Gawalko M, Elliott A, Hendriks JM, Franssen FM, Slats AM, van Empel VP, Van Gelder IC, Thijssen DH, Eijsvogels TM, Leue C, Crijns HJ, Linz D, Simons SO. Dyspnea in patients with atrial fibrillation: Mechanisms, assessment and an interdisciplinary and integrated care approach. IJC Heart & Vasculature 2022; 42:101086. [PMID: 35873859 PMCID: PMC9304702 DOI: 10.1016/j.ijcha.2022.101086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) is the most common sustained heart rhythm disorder and is often associated with symptoms that can significantly impact quality of life and daily functioning. Palpitations are the cardinal symptom of AF and many AF therapies are targeted towards relieving this symptom. However, up to two-third of patients also complain of dyspnea as a predominant self-reported symptom. In clinical practice it is often challenging to ascertain whether dyspnea represents an AF-related symptom or a symptom of concomitant cardiovascular and non-cardiovascular comorbidities, since common AF comorbidities such as heart failure and chronic obstructive pulmonary disease share similar symptoms. In addition, therapeutic approaches specifically targeting dyspnea have not been well validated. Thus, assessing and treating dyspnea can be difficult. This review describes the latest knowledge on the burden and pathophysiology of dyspnea in AF patients. We discuss the role of heart rhythm control interventions as well as the management of AF risk factors and comorbidities with the goal to achieve maximal relief of dyspnea. Given the different and often complex mechanistic pathways leading to dyspnea, dyspneic AF patients will likely profit from an integrated multidisciplinary approach to tackle all factors and mechanisms involved. Therefore, we propose an interdisciplinary and integrated care pathway for the work-up of dyspnea in AF patients.
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Affiliation(s)
- Rachel M.J. van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Astrid N.L. Hermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Nikki A.H.A. Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Germany
- 1st Department of Cardiology, Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Adrian Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Jeroen M. Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Annelies M. Slats
- Department of Respiratory Medicine, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Vanessa P.M. van Empel
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Isabelle C. Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dick H.J. Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thijs M.H. Eijsvogels
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
- School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, the Netherlands
| | - Harry J.G.M. Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Corresponding author at: Maastricht UMC+, Maastricht Heart+Vascular Center, 6202 AZ Maastricht.
| | - Sami O. Simons
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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7
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Hermans ANL, Gawalko M, Slegers DPJ, Andelfinger N, Pluymaekers NAHA, Verhaert DVM, van der Velden RMJ, Betz K, Evens S, Luermans JGLM, den Uijl DW, Baumert M, Nguyen HL, Isaksen JL, Kanters JK, Rienstra M, Vernooy K, Van Gelder IC, Hendriks JM, Linz D. Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation. Int J Cardiol 2022; 367:29-37. [PMID: 35963443 DOI: 10.1016/j.ijcard.2022.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The assessment of symptom-rhythm correlation (SRC) in patients with persistent atrial fibrillation (AF) is challenging. Therefore, we performed a novel mobile app-based approach to assess SRC in persistent AF. METHODS Consecutive persistent AF patients planned for electrical cardioversion (ECV) used a mobile app to record a 60-s photoplethysmogram (PPG) and report symptoms once daily and in case of symptoms for four weeks prior and three weeks after ECV. Within each patient, SRC was quantified by the SRC-index defined as the sum of symptomatic AF recordings and asymptomatic non-AF recordings divided by the sum of all recordings. RESULTS Of 88 patients (33% women, age 68 ± 9 years) included, 78% reported any symptoms during recordings. The overall SRC-index was 0.61 (0.44-0.79). The study population was divided into SRC-index tertiles: low (<0.47), medium (0.47-0.73) and high (≥0.73). Patients within the low (vs high) SRC-index tertile had more often heart failure and diabetes mellitus (both 24.1% vs 6.9%). Extrasystoles occurred in 19% of all symptomatic non-AF PPG recordings. Within each patient, PPG recordings with the highest (vs lowest) tertile of pulse rates conferred an increased risk for symptomatic AF recordings (odds ratio [OR] 1.26, 95% coincidence interval [CI] 1.04-1.52) and symptomatic non-AF recordings (OR 2.93, 95% CI 2.16-3.97). Pulse variability was not associated with reported symptoms. CONCLUSIONS In patients with persistent AF, SRC is relatively low. Pulse rate is the main determinant of reported symptoms. Further studies are required to verify whether integrating mobile app-based SRC assessment in current workflows can improve AF management.
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Affiliation(s)
- Astrid N L Hermans
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany; 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Daniek P J Slegers
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Nora Andelfinger
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dominique V M Verhaert
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rachel M J van der Velden
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Konstanze Betz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | | | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dennis W den Uijl
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Hien L Nguyen
- School of Electrical and Electronic Engineering, The University of Adelaide, Adelaide, SA, Australia
| | - Jonas L Isaksen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen K Kanters
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
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8
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Gawalko M, Hermans ANL, Van Der Velden RMJ, Betz K, Verhaert DVM, Pluymaekers NAHA, Vernooy K, Sultan A, Pison L, Manninger M, Duncker D, Evans S, Sohaib A, Linz D, Hendriks JM. Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring infrastructure for atrial fibrillation management through teleconsultation. TeleCheck-AF project results. Europace 2022. [DOI: 10.1093/europace/euac053.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
TeleCheck-AF is a mobile health (mHealth) infrastructure developed to provide remote management and comprehensive care to patients with atrial fibrillation (AF) during the Covid disease-19 pandemic lockdown within cardiology centers in Europe. TeleCheck-AF integrates an on-demand photoplethysmography-based heart rate/rhythm monitoring application supported a scheduled teleconsultation.
Purpose
The current sub-study of the TeleCheck-AF project aimed to provide the first real-world dataset on patient adherence and motivation to a standardized mHealth application integrated in remote AF management.
Methods
Patients were instructed to perform 60-second app-based heart rate/rhythm recordings three times daily and in case of symptoms for seven consecutive days prior to teleconsultation. Motivation was defined as number of days in which the expected number of measurements (≥three/day) were performed per number of days over the entire prescription period. Adherence was defined as number of performed measurements per number of expected measurements over the entire prescription period.
Results
Data from 990 consecutive patients with diagnosed AF (median age 64 [57-71] years, 39% female) from 10 centers that included the highest number of patients (≥25) were analyzed. Patients with both optimal motivation (100%) and adherence (≥100%) constituted 28% of the study population and had a lower percentage of recordings in sinus rhythm (90 [53-100%] vs 100 [64-100%], P<0.001) compared to others. Age and diabetes were predictors of both optimal motivation and adherence (odds ratio [OR] 1.02, 95% coincidence interval [95% CI] 1.01-1.04, P<0.001 and OR, 0.49, 95% CI 0.28-0.86, P=0.013, respectively). Patients with 100% motivation also had ≥100% adherence. Independent predictors for optimal adherence alone were age (OR 1.02, 95% CI 1.00-1.04, P=0.014), female sex (OR 1.70, 95% CI 1.29-2.23, P<0.001), previous AF ablation (OR 1.35, 95%CI 1.03-1.07, P=0.028).
Conclusion
In the TeleCheck-AF project, older age and diabetes were predictors of optimal patient motivation and adherence to app-based heart rate/rhythm monitoring. Therefore, physicians, nurses and allied health specialists involved in the management and care for patients with AF should not be discouraged to provide a mHealth infrastructure to elderly patients. Patient engagement improves mHealth adherence/motivation, hence, it is crucial to tailor the mHelath intervention to the needs and preferences of the patient.
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Affiliation(s)
- M Gawalko
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - ANL Hermans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - RMJ Van Der Velden
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - K Betz
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - DVM Verhaert
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - NAHA Pluymaekers
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - K Vernooy
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - A Sultan
- Heart Center at the University of Cologne, Department of Electrophysiology, Cologne, Germany
| | - L Pison
- Hospital Oost-Limburg (ZOL), Department of Cardiology, Genk, Belgium
| | - M Manninger
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - D Duncker
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - S Evans
- Qompium NV, Hasselt, Belgium
| | - A Sohaib
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - D Linz
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - JM Hendriks
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
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9
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Verhaert D, Betz K, Gawalko M, Hermans ANL, Van Der Velden RMJ, Westra SW, Schotten U, Hendriks JM, Vernooy K, Linz D. The impact of a structured polygraphy screening incorporated in a novel remote mobile health pathway on sleep apnoea prevalence in patients with atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Untreated obstructive sleep apnoea (OSA) contributes to progression of atrial fibrillation (AF) and reduces the success rate of heart rhythm control strategies. OSA remains one of the most frequently underdiagnosed modifiable risk factors in AF patients due to a lack of standardized screening methods and low awareness.
Purpose
To assess the impact of implementation of a structured remote OSA screening and management pathway on the prevalence of OSA in AF patients scheduled for AF ablation procedures.
Methods
In October 2020, a novel remote OSA screening and management pathway (VIRTUAL-SAFARI) was introduced in two AF outpatient clinics in the Netherlands. Consecutive patients scheduled for AF ablation were offered OSA screening consisting of sending a portable home sleep test to patients’ homes to perform a remote sleep recording for one night, analysis by a sleep physician, discussion of results with the patient, and initiation of treatment (when applicable). The impact of this structural screening strategy was assessed by comparing the prevalence of concomitant OSA (defined as apnoea-hypopnoea index ≥5) for patients scheduled for AF ablation in the year before and after introduction of the OSA management pathway.
Results
A total of 733 patients was studied, 308 in the year before (Oct ’19 - Sep ’20) and 425 in the year after (Oct ’20 - Sep ’21) introduction of the VIRTUAL-SAFARI pathway. Median age was 65 [58-71], 64% was male and median body mass index (BMI) was 27 [25-30] kg/m2. Baseline characteristics were comparable for the groups before and after introduction of the pathway (Table 1).
In the cohort before pathway introduction, OSA had been diagnosed in 26 patients (8%, Figure 1) and was treated with positive airway pressure in 10 cases (3%).
In the cohort after pathway introduction, OSA had previously been diagnosed in 53 patients (12%). Eighty-eight percent of patients without previous OSA screening was referred via the remote pathway. Results of the sleep recordings were available for 213 (59%) at the time of this analysis. Previously unknown OSA was diagnosed in 184 patients (86% of available recordings), increasing the prevalence of confirmed OSA to 237 (55%). For 22% of patients, results of sleep recordings are pending. Absence of OSA was confirmed in 9%, and 13% of patients had not been screened (e.g. because of patient preference or logistical reasons). After pathway introduction, 82 patients (19%) were treated or received advice to start treatment with positive airway pressure. Treatment decisions are pending for 9% of the cohort.
Conclusion
After the implementation of structured remote OSA screening in a well characterized cohort of consecutive patients scheduled for AF ablation, the prevalence of diagnosed OSA increased from 8% to 55%. Whether appropriate risk factor management, including treatment of OSA identified by structured screening, will improve AF outcomes needs to be tested in future studies.
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Affiliation(s)
- D Verhaert
- Radboud University Medical Center, Department of cardiology, Radboud Institute of Health Sciences (RIHS), Nijmegen, Netherlands (The)
| | - K Betz
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - M Gawalko
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - ANL Hermans
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - RMJ Van Der Velden
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - SW Westra
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - U Schotten
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - JM Hendriks
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K Vernooy
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
| | - D Linz
- Maastricht University Medical Centre (MUMC), Department of cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands (The)
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10
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Gawalko M, Kaplon-Cieslicka A, Budnik M, Scislo P, Piatkowski R, Kochanowski J, Opolski G, Grabowski M. Left atrial thrombus in atrial fibrillation/flutter patients in relation to anticoagulation strategy: LATTEE registry. Europace 2022. [DOI: 10.1093/europace/euac053.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Atrial fibrillation (AF) and flutter (AFl) increase the risk of thromboembolism by promoting clot formation in the left atrium. Current guidelines recommend initiation of oral anticoagulation (OAC) with vitamin K antagonists (VKAs) or, preferably, non-VKA-OACs (NOACs) in men and women with a CHA2DS2VASc score of ≥2 and ≥3, respectively. Effective OAC is also recommended 3 weeks before elective AF cardioversion or catheter ablation with pre-procedural ttransesophageal echocardiography (TEE) as an alternative. However, TEE before AF/AFl cardioversion or ablation is often performed even in anticoagulated patients, given that, in clinical practice, "effective" OAC may be difficult to achieve and/or verify.
Purpose
The aim of the study was to assess the prevalence of left atrial thrombus (LAT) in AF/AFl in relation to OAC strategy.
Methods
The Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) registry was a prospective, observational study enrolling consecutive patients with AF or AFl in whom TEE was performed before direct current cardioversion or catheter ablation, hospitalized in 13 cardiology departments in Poland. Patients’ recruitment process started from November 2018 in the coordinating centre and lasted 12 months since the beginning of the study in each participating centre or longer, i.e., until the inclusion of at least 200 patients at each participating centre (with the last patient enrolled in May 2020).
Results
Of 3109 patients enrolled, 88% were on chronic, 1.5% on transient OAC and 10% without OAC. Of patients on chronic OAC, 39% received rivaroxaban, 30% dabigatran, 14% apixaban and 18% vitamin K antagonists (VKA). Patients on apixaban were oldest, had worst renal function and highest both bleeding and thromboembolic risk, and more often received reduced doses. Overall, prevalence of LAT was 8.0% (7.3% on chronic OAC vs. 15% without OAC; p<0.01). In patients on VKA, prevalence of LAT was doubled compared to patients on non-VKA-OACs (NOACs) (13% vs. 6.0%; p<0.01), even after propensity score matching (13% vs. 7.5%; p<0.01) and in multivariable logistic regression (OR 1.9, 95% confidence interval 1.4-2.8). Prevalence of LAT in patients on apixaban was higher (9.8%) than in those on rivaroxaban (5.7%) and dabigatran (4.7%; p<0.01 for both comparisons). However, in propensity score matching and multivariable logistic regression, there was no difference in the risk of LAT between apixaban and other NOACs.
Conclusions
Prevalence of LAT in AF is non-negligible even on chronic OAC. In the real-world AF/AFl population, the risk of LAT seems higher on VKA compared to NOAC, and similar between different NOACs.
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Affiliation(s)
- M Gawalko
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - A Kaplon-Cieslicka
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - M Budnik
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - P Scislo
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - R Piatkowski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - J Kochanowski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - G Opolski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - M Grabowski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
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11
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Hermans ANL, Gawalko M, Pluymaekers NAHA, Verhaert DVM, Van Der Velden RMJ, Betz K, Evens S, Luermans JGLM, Den Uijl DW, Baumert M, Vernooy K, Rienstra M, Van Gelder IC, Hendriks JM, Linz D. Mobile app-based symptom-rhythm correlation assessment in patients with persistent atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
In patients with persistent atrial fibrillation (AF) it is difficult to determine the association between patient self-reported symptoms and the underlying heart rhythm (symptom-rhythm correlation [SRC]). No standardized strategy to assess SRC in AF patients is available.
Purpose
We assessed for the first time SRC in persistent AF patients using a mobile health approach of simultaneous photoplethysmography (PPG)-based rhythm monitoring and active interrogation of patient-reported symptoms, which provides a novel approach to systematically assess SRC in persistent AF.
Methods
Consecutive persistent AF patients planned for electrical cardioversion (ECV) used a mobile app to record a 60-second PPG and report symptoms once daily and in case of symptoms for four weeks prior and three weeks after ECV. Within each patient, SRC was quantified by the SRC-index defined as the sum of symptomatic AF recordings and asymptomatic non-AF recordings divided by the sum of all recordings.
Results
Of 88 patients (33% female, age 68±9 years) included, 78% reported any symptoms during recordings. The overall SRC-index was 0.61 (0.44-0.79). The study population was divided into SRC-index tertiles: low (<0.47), medium (0.47-0.73) and high (≥0.73). Patients within the low (vs high) SRC-index tertile had more often heart failure and diabetes mellitus (both 24.1% vs 6.9%). Extrasystoles occurred in 19% of all symptomatic non-AF PPG recordings. Within each patient, PPG recordings with the highest (vs lowest) tertile of pulse rates conferred an increased risk for symptomatic AF recordings (odds ratio [OR] 1.26, 95% coincidence interval [CI] 1.04-1.52) and symptomatic non-AF recordings (OR 2.93, 95% CI 2.16-3.97). Pulse variability was not associated with reported symptoms.
Conclusion
In persistent AF patients, simultaneous mobile app-based symptom and rhythm monitoring revealed a relatively low overall SRC, suggesting that the majority of patients experienced symptoms irrespective of AF. Extrasystoles can explain a minority of symptomatic non-AF PPG recordings. Pulse rate, but not pulse variability, is the main determinant of reported symptoms during AF and non-AF PPG recordings. Further studies are required to test whether mobile app-based SRC assessment can be implemented in current workflows and integrated into a personalized symptom and rhythm control AF management approach.
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Affiliation(s)
- ANL Hermans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - M Gawalko
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - NAHA Pluymaekers
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - DVM Verhaert
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - RMJ Van Der Velden
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - K Betz
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - S Evens
- Qompium NV, Hasselt, Belgium
| | - JGLM Luermans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - DW Den Uijl
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - M Baumert
- University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, Australia
| | - K Vernooy
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - M Rienstra
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands (The)
| | - IC Van Gelder
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands (The)
| | - JM Hendriks
- Flinders University, Caring Futures Institute, College of Nursing and Health Sciences, Adelaide, Australia
| | - D Linz
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
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12
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Van Der Velden RMJ, Pluymaekers NAHA, Dudink EAMP, Timmermans TAFM, Hermans ANL, Gawalko M, Verhaert DVM, Betz K, Luermans JGLM, Crijns HJGM, Linz D. Impact of the RACE 7 ACWAS trial on patient behaviour, referral and treatment strategies at the emergency department: patient perspectives. Europace 2022. [DOI: 10.1093/europace/euac053.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
In the Rate Control versus Electrical Cardioversion Trial 7–Acute Cardioversion versus Wait and See (RACE 7 ACWAS) trial, a delayed cardioversion approach was compared to early cardioversion. Based on the results of this trial, the delayed cardioversion approach has been added to the European Society of Cardiology guidelines for atrial fibrillation (AF) as a strategy for the acute management of patients with recent-onset AF episodes.
Purpose
The aim of this study was to evaluate the impact of participation in the RACE 7 ACWAS trial, in combination with education on the delayed cardioversion approach, on the behaviour of patients regarding their recent-onset AF episodes.
Methods
Patients who were enrolled in the RACE 7 ACWAS trial in our centre and who gave their consent to be approached for future research projects were asked to complete a questionnaire, asking about AF recurrences and related treatment after their participation in the RACE 7 ACWAS trial.
Results
Of the 148 patients enrolled in the RACE 7 ACWAS trial in our centre, 130 patients were eligible for this study. Of these patients, 16 refused participation, 25 could not be reached and 16 did not return the questionnaire. Seventy-three patients (mean age 69, 64.4% men, 50.7% delayed cardioversion group) completed the questionnaire and were included in the current analysis. Forty-nine patients (67.1%) experienced AF recurrences after the trial. Of the patients with AF recurrences, 23 patients (46%) indicated that since their participation in the trial they have been waiting longer for spontaneous conversion to occur, i.e. 13 patients (26%) wait longer before contacting the emergency department (ED) and 10 patients (20%) wait as long as it takes for spontaneous conversion to occur. Twenty-five patients (51.0%) had been to the ED because of AF at least one time after their participation in the RACE 7 ACWAS trial. Eleven patients (45.8%) who contacted the ED were advised to wait at home a while longer before visiting the ED. In 13 patients (52%) a delayed cardioversion approach at the ED was applied at least once. Eleven patients experiencing recurrences (22.9%) indicated that ED visits had been avoided because the ED advised them telephonically to await spontaneous conversion longer (Figure 1). There were no significant differences between patients who were in the early cardioversion group compared to patients who were in the delayed cardioversion group (Table 1).
Conclusion
The RACE 7 ACWAS trial appears to have impacted the behaviour of approximately half of the included patients, who indicated that following participation in the trial they were more likely to await spontaneous conversion. Health care professionals at the ED adopted a delayed cardioversion strategy in half of all cases. In about 1 in every 4-5 patients, an ED visit was avoided because patients were telephonically advised to wait longer.
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Affiliation(s)
- RMJ Van Der Velden
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - NAHA Pluymaekers
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - EAMP Dudink
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - TAFM Timmermans
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - ANL Hermans
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - M Gawalko
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - DVM Verhaert
- Radboud University Medical Center, Cardiology, Nijmegen, Netherlands (The)
| | - K Betz
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - JGLM Luermans
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - HJGM Crijns
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - D Linz
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
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13
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Betz K, Verhaert DVM, Gawalko M, Hermans ANL, Van Der Velden RMJ, Schotten U, Vernooy K, Hendriks J, Linz D. Performance of STOP-BANG questionnaire as sleep apnoea screening tool and development of a novel pre-selection model in patients with atrial fibrillation - insights from the Virtual-SAFARI study. Europace 2022. [DOI: 10.1093/europace/euac053.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Sleep-disordered breathing (SDB) is highly prevalent in patients with atrial fibrillation (AF) and its screening is recommended in this population. The STOP-BANG questionnaire is widely used as SDB screening tool, but the subjective assessment of some of its parameters might limit its validity to detect SDB in AF patients.
Purpose
We assessed the performance of the STOP-BANG questionnaire to detect SDB with the use of a mobile health-based portable home sleep test given as reference in a cohort of AF patients. Moreover, we explored options to improve pre-selection for SDB screening in this cohort.
Methods
Consecutive AF patients who were referred for AF catheter ablation in two AF outpatient clinics and without previous history of SDB and/or SDB screening, were included prospectively. Patients characteristics together with STOP-BANG questionnaire were assessed at baseline visitation. STOP-BANG scores of 3-4 and 5-8 were interpreted as intermediate and high risk for SDB, respectively. All patients were digitally referred to a virtual SDB management pathway, independent of STOP-BANG score. Patients received a portable home sleep test to detect SDB, which patients used for one night at home after instructions. Sleep recordings were accessed by sleep physicians via a secured cloud and sleep reports were discussed with patients and referring physicians. Apnoea-hypopnoea-indexes (AHI) of >=15 and of >= 30 were interpreted as moderate-to-severe and severe SDB, respectively. Results of the STOP-BANG and the home sleep test were compared and performance of the STOP-BANG questionnaire was assessed. Uni- and multivariable logistic regression analyses based on patient characteristics were used to construct a nomogram to improve pre-selection for SDB screening in this cohort.
Results
A total of 156 patients (median age 65 years, 63.8% male) were included. According to results from the home sleep test, 53% of patients were diagnosed with moderate-to-severe SDB, including 16% with severe SDB. STOP-BANG questionnaire performed poorly with an area under the receiver operating characteristic curve (AUROC) of 0.661 and 0.684 in predicting moderate-to-severe and severe SDB, respectively. On multivariable logistic analysis, independent predictors for moderate-to-severe SDB were body-mass-index (BMI), age and apnoeas. A nomogram was built on this variables (Fig. 1), which performed good with an AUROC of 0.728 in predicting moderate-to-severe SDB.
Conclusion
In a cohort of AF patients scheduled for AF catheter ablation, SDB was highly prevalent. STOP-BANG questionnaire had poor value for the prediction of moderate-to-severe and severe SDB compared to a systematical SDB screening via home sleep test. Using STOP-BANG questionnaire as a pre-selection tool might lead to frequently undetected and untreated SDB. Whether the nomogram based on our analyses improves pre-selection for SDB screening in AF patients will be validated in a future cohort.
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Affiliation(s)
- K Betz
- Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, Netherlands (The)
| | - DVM Verhaert
- Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, Netherlands (The)
| | - M Gawalko
- Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, Netherlands (The)
| | - ANL Hermans
- Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, Netherlands (The)
| | - RMJ Van Der Velden
- Cardiovascular Research Institute Maastricht (CARIM), Department of Cardiology, Maastricht, Netherlands (The)
| | - U Schotten
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - K Vernooy
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - J Hendriks
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
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14
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Abstract
Oral anticoagulation is obligatory in patients with atrial fibrillation (AF) to prevent thromboembolic stroke. Direct direct oral anticoagulants (DOAC) exhibit improved safety over Vitamin K antagonists, but any interference in haemostasis can impact on bleeding. Optimal anticoagulation remains challenging particularly in patients with co-morbidities. International Society of Thrombosis and Haemostasis (ISTH) guidelines recommend avoiding DOAC in patients with severe obesity, and systematic data on individual DOAC drug concentrations, clinical efficacy and safety in relation to body weight are lacking. A new study now provides reassurance that DOAC are safe and effective in a real-world cohort of morbidly obese patients, going some way to fill the knowledge gap pertaining to optimal management of concomitant obesity and AF.
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Affiliation(s)
- Anke C Fender
- Institute of Pharmacology, Medical Faculty, University Duisburg-Essen, Germany
| | - Monika Gawalko
- Institute of Pharmacology, Medical Faculty, University Duisburg-Essen, Germany.,Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.,1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dobromir Dobrev
- Institute of Pharmacology, Medical Faculty, University Duisburg-Essen, Germany
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15
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Hermans ANL, Gawalko M, Van Der Velden RMJ, Verhaert DVM, Betz K, Hemels MEW, Steven D, Duncker D, Gupta D, Manninger M, Lodzinski P, Crijns HJGM, Pluymaekers NAHA, Hendriks JM, Linz D. 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. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previously, we introduced the TeleCheck-AF approach, which is an on-demand mobile health (mHealth) infrastructure incorporating mobile app-based heart rate and rhythm monitoring as well as mobile app-based self-reported atrial fibrillation (AF) risk factor assessment to allow comprehensive remote AF management through teleconsultation. Herein, we evaluated the feasibility and accuracy of remote mobile app-based self-reported AF risk factor assessment in AF patients.
Methods
In our University Medical Center, 545 patients were managed within the TeleCheck-AF project by an on-demand heart rate and rhythm mHealth infrastructure through teleconsultation. Patients were asked to fill in a short mobile app-based 10-item questionnaire related to AF risk factors. A reminder to complete the questionnaire automatically popped-up after the following four heart rate and rhythm recordings. Furthermore, patient's medical history was retrieved from the electronic health records (EHRs).
Results
Out of 545 patients, 542 (99.4%) patients (217 female, age 67 (59–72) years) completed the mobile app-based 10-item questionnaire and were included in this analysis. The number of patients with diabetes mellitus was similar in the EHRs and mobile app-based questionnaire (both 11.3%, p=1.000). There was no significant difference in the number of patients who had a medical history of transient ischemic attack (TIA)/cerebrovascular accident (CVA) and artery disease (coronary artery disease and peripheral artery disease) in the EHRs and mobile app-based questionnaire (11.4% vs 12.2%, p=0.608 and 14.8% vs 13.3%, p=0.366, respectively). Heart failure was more frequently reported in the mobile app-based questionnaire compared to the EHRs (33.4% vs 14.0%, p<0.001). A total of 260 (48.0%) patients had a diagnosis of hypertension verified in EHRs and only 239 (44.1%) patients reported hypertension in the mobile app-based questionnaire (p=0.044). There was no significant difference in number of patients with CHA2DS2-VASc-score ≥2 between the EHRs and mobile app-based questionnaire (64.2% vs 66.1%, p=0.275). The accuracy of mobile app-based assessment of diabetes mellitus was 85.4%, of TIA/CVA 78.9%, of artery disease 60.9%, of heart failure 78.8%, and of hypertension 89.3%.
Conclusion
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.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A N L Hermans
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - M Gawalko
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | | | - D V M Verhaert
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - K Betz
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | | | - D Steven
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - D Duncker
- Hannover Heart Center, Hannover, Germany
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | - P Lodzinski
- Medical University of Warsaw, Warsaw, Poland
| | - H J G M Crijns
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | | | | | - D Linz
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
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16
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Van Der Velden RMJ, Verhaert DVM, Hermans ANL, Gawalko M, Duncker D, Manninger M, Hemels M, Pisters R, Lodzinski P, Steven D, Sultan A, Crijns HJGM, Pluymaekers NAHA, Hendriks JM, Linz D. The photoplethysmography dictionary: practical guidance on signal interpretation and clinical scenarios from TeleCheck-AF. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
During the coronavirus disease 2019 (COVID-19) pandemic, numerous centres in Europe used on-demand photoplethysmography (PPG) technology to remotely assess heart rate and rhythm in conjunction with teleconsultations within the TeleCheck-AF project.
Purpose
To develop an educational structured stepwise practical guide on how to interpret PPG signals and to study typical clinical scenarios how on-demand PPG was used in the TeleCheck-AF project.
Methods
During an online conference, the structured stepwise practical guide on how to interpret PPG signals was discussed and further refined during an internal review process. We provide the number of respective PPG recordings and number of patients managed within a clinical scenario during the TeleCheck-AF project.
Results
To interpret PPG recordings, we introduce a structured stepwise practical guide and provide representative PPG recordings. In the TeleCheck-AF project, 2522 subjects collected 90.616 recordings. The majority of these recordings was classified by the PPG algorithm as sinus rhythm (57.6%), followed by atrial fibrillation (AF) (23.6%). In 9.7% of recordings the quality was too low to interpret. Other observed rhythms were tachycardia (1.4%), extra systoles (4.7%), bigeminy episodes (1.8%), trigeminy episodes (0.6%) and atrial flutter (0.2%). The most frequent clinical scenario where PPG technology was used in the TeleCheck-AF project was follow-up after AF ablation (1110 patients) followed by heart rate and rhythm assessment around (tele)consultation (966 patients), sometimes including remote PPG-guided adaption of rate or rhythm control. 275 patients were followed around cardioversion, either (semi-)acute or elective. Other possible scenarios are assessment of palpitations, assessment of symptom-rhythm correlation and monitoring during up-titration of heart failure medication.
Conclusion
We introduce a newly developed structured stepwise practical guide on PPG signal interpretation developed based on presented experiences from TeleCheck-AF. The present clinical scenarios for the use of on-demand PPG technology derived from the TeleCheck-AF project will help to implement PPG technology in the management of arrhythmia patients.
Funding Acknowledgement
Type of funding sources: None. TeleCheck-AF clinical scenariosClassification of PPG recordings
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Affiliation(s)
- R M J Van Der Velden
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - D V M Verhaert
- Radboud University Medical Center, Cardiology, Nijmegen, Netherlands (The)
| | - A N L Hermans
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - M Gawalko
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - D Duncker
- Hannover Heart Center, Cardiology, Hannover, Germany
| | - M Manninger
- Medical University of Graz, Cardiology, Graz, Austria
| | - M Hemels
- Rijnstate Hospital, Cardiology, Arnhem, Netherlands (The)
| | - R Pisters
- Rijnstate Hospital, Cardiology, Arnhem, Netherlands (The)
| | - P Lodzinski
- Medical University of Warsaw, Cardiology, Warsaw, Poland
| | - D Steven
- University hospital Köln, Electrophysiology, Cologne, Germany
| | - A Sultan
- University hospital Köln, Electrophysiology, Cologne, Germany
| | - H J G M Crijns
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - N A H A Pluymaekers
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
| | - J M Hendriks
- Royal Adelaide Hospital, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D Linz
- Maastricht University Medical Centre (MUMC), Cardiology, Maastricht, Netherlands (The)
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17
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Hermans ANL, Gawalko M, Dohmen L, van der Velden RMJ, Betz K, Verhaert DVM, Pluymaekers NAHA, Hendriks JM, Linz D. A systematic review of mobile health opportunities for atrial fibrillation detection and management. Eur J Prev Cardiol 2021; 29:e205-e208. [PMID: 34550370 DOI: 10.1093/eurjpc/zwab158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Astrid N L Hermans
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.,Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany.,1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-197 Warsaw, Poland
| | - Lisa Dohmen
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Rachel M J van der Velden
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Konstanze Betz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Dominique V M Verhaert
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt North Sturt Rd, Bedford Park SA 5042, Adelaide, Australia
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Center and Radboud Institute for Health Sciences, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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18
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Betz K, van der Velden R, Gawalko M, Hermans A, Pluymaekers N, Hillmann HAK, Hendriks J, Duncker D, Linz D. [Interpretation of photoplethysmography: a step-by-step guide]. Herzschrittmacherther Elektrophysiol 2021; 32:406-411. [PMID: 34304276 PMCID: PMC8310409 DOI: 10.1007/s00399-021-00795-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 11/05/2022]
Abstract
By applying photoplethysmography (PPG), the camera of the mobile phone can be used to remotely assess heart rate and rhythm, which was widely used in conjunction with teleconsultations within the TeleCheck-AF project during the coronavirus disease 2019 (COVID-19) pandemic. Herein, we provide an educational, structured, stepwise practical guide on how to interpret PPG signals. A better understanding of PPG recordings is critical for the implementation of this widely available technology into clinical practice.
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Affiliation(s)
- Konstanze Betz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht UMC+, 6202 AZ, Maastricht, Niederlande
| | - Rachel van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht UMC+, 6202 AZ, Maastricht, Niederlande
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht UMC+, 6202 AZ, Maastricht, Niederlande
| | - Astrid Hermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht UMC+, 6202 AZ, Maastricht, Niederlande
| | - Nikki Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht UMC+, 6202 AZ, Maastricht, Niederlande
| | - Henrike A K Hillmann
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Deutschland
| | - Jeroen Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australien
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Niederlande
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Deutschland
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht UMC+, 6202 AZ, Maastricht, Niederlande.
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, Niederlande.
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australien.
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Kopenhagen, Dänemark.
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19
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van der Velden RMJ, Verhaert DVM, Hermans ANL, Duncker D, Manninger M, Betz K, Gawalko M, Desteghe L, Pisters R, Hemels M, Pison L, Sohaib A, Sultan A, Steven D, Wijtvliet P, Gupta D, Svennberg E, Luermans JCLM, Chaldoupi M, Vernooy K, den Uijl D, Lodzinski P, Jansen WPJ, Eckstein J, Bollmann A, Vandervoort P, Crijns HJGM, Tieleman R, Heidbuchel H, Pluymaekers NAHA, Hendriks JM, Linz D. The photoplethysmography dictionary: practical guidance on signal interpretation and clinical scenarios from TeleCheck-AF. Eur Heart J Digit Health 2021; 2:363-373. [PMID: 36713592 PMCID: PMC9707923 DOI: 10.1093/ehjdh/ztab050] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 02/01/2023]
Abstract
Aims Within the TeleCheck-AF project, numerous centres in Europe used on-demand photoplethysmography (PPG) technology to remotely assess heart rate and rhythm in conjunction with teleconsultations. Based on the TeleCheck-AF investigator experiences, we aimed to develop an educational structured stepwise practical guide on how to interpret PPG signals and to introduce typical clinical scenarios how on-demand PPG was used. Methods and results During an online conference, the structured stepwise practical guide on how to interpret PPG signals was discussed and further refined during an internal review process. We provide the number of respective PPG recordings (FibriCheck®) and number of patients managed within a clinical scenario during the TeleCheck-AF project. To interpret PPG recordings, we introduce a structured stepwise practical guide and provide representative PPG recordings. In the TeleCheck-AF project, 2522 subjects collected 90 616 recordings in total. The majority of these recordings were classified by the PPG algorithm as sinus rhythm (57.6%), followed by AF (23.6%). In 9.7% of recordings, the quality was too low to interpret. The most frequent clinical scenarios where PPG technology was used in the TeleCheck-AF project was a follow-up after AF ablation (1110 patients) followed by heart rate and rhythm assessment around (tele)consultation (966 patients). Conclusion We introduce a newly developed structured stepwise practical guide on PPG signal interpretation developed based on presented experiences from TeleCheck-AF. The present clinical scenarios for the use of on-demand PPG technology derived from the TeleCheck-AF project will help to implement PPG technology in the management of AF patients.
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Affiliation(s)
- Rachel M J van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Dominique V M Verhaert
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Astrid N L Hermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - David Duncker
- Department of Cardiology and Angiology, Hannover Heart Rhythm Center, Hannover Medical School, Hannover, Germany
| | - Martin Manninger
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Konstanze Betz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Lien Desteghe
- Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium,Department of Cardiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Ron Pisters
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Martin Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Laurent Pison
- Department of Cardiology, Hospital East Limburg, Genk, Belgium
| | - Afzal Sohaib
- Department of Cardiology, St Bartholomew’s Hospital, Bart’s Health NHS Trust, London, UK,Department of Cardiology, King George Hospital, London, UK
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Petra Wijtvliet
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,Department of Cardiology, Martini Ziekenhuis, Groningen, The Netherlands
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Emma Svennberg
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Justin C L M Luermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marisevi Chaldoupi
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Dennis den Uijl
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Piotr Lodzinski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Ward P J Jansen
- Department of Cardiology, Tergooi Hospital, Hilversum, the Netherlands
| | - Jens Eckstein
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Robert Tieleman
- Department of Cardiology, Martini Ziekenhuis, Groningen, The Netherlands
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia,Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark,Corresponding author. Tel: +31(0)43-3875093,
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20
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Pluymaekers NAHA, van der Velden RMJ, Hermans ANL, Gawalko M, Buskes S, Keijenberg JJHMW, Vorstermans B, Crijns HJGM, Hendriks JM, Linz D. On-Demand Mobile Health Infrastructure for Remote Rhythm Monitoring within a Wait-and-See Strategy for Recent-Onset Atrial Fibrillation: TeleWAS-AF. Cardiology 2021; 146:392-396. [PMID: 33735889 DOI: 10.1159/000514156] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
Recently, we introduced the TeleCheck-AF approach, an on-demand mobile health (mHealth) infrastructure using app-based heart rate and rhythm monitoring for 7 days, to support long-term atrial fibrillation (AF) management through teleconsultation. Herein, we extend the mHealth approach to patients with recent-onset AF at the emergency department (ED). In the proposed TeleWAS-AF approach, on-demand heart rate and rhythm monitoring are used to support a wait-and-see strategy at the ED. All stable patients who present to the ED with recent-onset symptomatic AF and who are able to use mHealth solutions for heart rate and rhythm monitoring are eligible for this approach. Patients will receive both education on AF and instructions on the use of the mHealth technology before discharge from the ED. A case coordinator will subsequently check whether patients are able to activate the mHealth solution and to perform heart rate and rhythm measurements. Forty hours after AF onset, the first assessment teleconsultation with the physician will take place, determining the need for delayed cardioversion. After maximal 7 days of remote monitoring, a second assessment teleconsultation may occur, in which the rhythm can be reassessed and further treatment strategy can be discussed with the patients. This on-demand mHealth prescription increases patient involvement in the care process and treatment decision-making by encouraging self-management, while avoiding excess data-load requiring work-intensive and expensive data management. Implementation of the TeleWAS-AF approach may facilitate the management of AF in the ED and reduce the burden on the ED system, which enhances the capacity for health care utilization.
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Affiliation(s)
- Nikki A H A Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Rachel M J van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Astrid N L Hermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Saskia Buskes
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Joyce J H M W Keijenberg
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Bianca Vorstermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands
| | - Jeroen M Hendriks
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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21
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Hermans ANL, Gawalko M, Pluymaekers NAHA, Dinh T, Weijs B, van Mourik MJW, Vorstermans B, den Uijl DW, Opsteyn L, Snippe H, Vernooy K, Crijns HJGM, Linz D, Luermans JGLM. Long-term intermittent versus short continuous heart rhythm monitoring for the detection of atrial fibrillation recurrences after catheter ablation. Int J Cardiol 2021; 329:105-112. [PMID: 33412184 DOI: 10.1016/j.ijcard.2020.12.077] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The utility of long-term intermittent heart rhythm monitoring after atrial fibrillation (AF) ablation remains unclear. Therefore, we compared the efficacy and usability of long-term intermittent (AliveCor Kardia® (ACK)) versus short continuous (Holter) heart rhythm monitoring for the detection of AF recurrences after AF ablation and evaluated ACK accuracy to detect AF. METHODS Patients were provided with Holter (for ≥24 h) simultaneously with an ACK (4 weeks) used three times a day and in case of symptoms. The primary endpoint was the difference in proportion of patients diagnosed with recurrent AF by ACK as compared to Holter monitoring. Secondary endpoints were the usability (System Usability Scale and a four-item questionnaire) of ACK and Holter monitoring; and the accuracy of the ACK algorithm for AF detection. RESULTS Out of 126 post-ablation patients, 115 (91.3%; 35 females, median age 64.0 [58.0-68.0] years) transmitted overall 7838 ACK ECG recordings. ACK and Holter monitoring detected 29 (25.2%) and 17 (14.8%) patients with AF recurrences, respectively (p < 0.001). More than 2 weeks of ACK monitoring did not have additional diagnostic yield for detection of AF recurrences. Patients graded ACK higher than Holter monitoring and found ACK more convenient in daily usage than Holter (p < 0.001). Sensitivity and specificity of ACK for AF detection were 95.3% and 97.5%, respectively. CONCLUSIONS Long-term intermittent monitoring by ACK more effectively detects AF recurrences after AF ablation and has a higher patients' usability than short continuous Holter monitoring. ACK showed a high accuracy to detect AF.
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Affiliation(s)
- Astrid N L Hermans
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Trang Dinh
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Bob Weijs
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology and Electrophysiology, Katholische Stiftung Marienhospital Aachen, Aachen, Germany
| | - Manouk J W van Mourik
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Bianca Vorstermans
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dennis W den Uijl
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Ludo Opsteyn
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Hilco Snippe
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Faculty of Health and Medical Sciences, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
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22
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Hermans A, Gawalko M, Pluymaekers N, Dinh T, Weijs B, Essers B, Van Mourik M, Vostermans B, Opsteyn L, Snippe H, Vernooy K, Linz D, Crijns H, Luermans J. Detection of atrial fibrillation recurrences after ablation: long-term intermittent versus short continuous heart rhythm monitoring. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Catheter based ablation therapy is an established treatment in patients with symptomatic atrial fibrillation (AF). Currently, the detection of AF recurrences after AF ablation is most frequently performed by short continuous heart rhythm monitoring, such as Holter monitoring. Our aim is to evaluate the effectiveness and accurateness of long-term intermittent rhythm monitoring using a single-lead ECG (AliveCor Kardia®) compared to short continuous monitoring with Holter for the detection of AF recurrences after ablation.
Methods
We conducted a prospective study of patients after AF ablation between May 2017 and October 2019. As standard of care, patients underwent Holter monitoring (minimum 24 hours) at 3, 6 and 12 months after ablation. At the same time patients were instructed to use an AliveCor Kardia (ACK) monitor to record a 30-second ECG three times a day and in case of symptoms for a period of four weeks. The primary endpoint was the difference in proportion of AF recurrences detected by ACK compared to Holter. Secondary endpoint was the sensitivity and specificity of ACK algorithm. Further, patients were asked to complete a questionnaire on the System Usability Scale to evaluate the usability for both ACK and Holter.
Results
Out of 126 post-ablation patients, 115 (91%) patients (35 female, age 63±8 years) transmitted their ACK recordings and were included in this analysis. A total of 7838 ECGs were assessed. The mean AKC usage time was 27+11 days, mean number of recordings 68+28 per patient. Our primary endpoint, the proportion of detection of recurrent AF, was almost twice as high in ACK (24%) than in Holter (14%, p<0.05). The ACK algorithm categorized 80% as normal sinus rhythm, 10% as possible AF, 10% as unclassified and 0.6% as unreadable. According to the interpretation of the researchers' team, 38 (0.5%) ECGs were uninterpretable and in 98% of the unclassified ECGs by ACK, the researchers' team was able to establish a diagnosis. The ACK diagnostic algorithm displayed a sensitivity of 95% and specificity of 98% for AF detection. The ACK diagnostic algorithm had a high likelihood of misclassifying premature atrial contractions and sinus rhythm accompanied by artifacts as AF (6.8% and 11% of all recordings assessed by AKC as AF, respectively). Based on the System Usability Scale, patients rated ACK as more acceptable in daily usage than Holter (75.0% versus 58.6% had an overall score above 70%, respectively).
Conclusions
ACK effectively and accurately detects AF recurrences in patients who underwent AF ablation and has a high patients' acceptability compared to Holter monitoring. Long-term intermittent rhythm monitoring may provide a promising tool for rhythm follow-up after AF ablation procedures.
Interpretation of ACK recordings
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A.N.L Hermans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - M Gawalko
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - N.A.H.A Pluymaekers
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - T Dinh
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - B Weijs
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - B.A.B Essers
- Maastricht University Medical Centre (MUMC), Department of Clinical Epidemiology & Medical Technology Assessment, Maastricht, Netherlands (The)
| | - M.J.W Van Mourik
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - B Vostermans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - L Opsteyn
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - H Snippe
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - K Vernooy
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - D Linz
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - H.J.G.M Crijns
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - J.G.L.M Luermans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
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23
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Hermans ANL, van der Velden RMJ, Gawalko M, Verhaert DVM, Desteghe L, Duncker D, Manninger M, Heidbuchel H, Pisters R, Hemels M, Pison L, Sohaib A, Sultan A, Steven D, Wijtvliet P, Tieleman R, Gupta D, Dobrev D, Svennberg E, Crijns HJGM, Pluymaekers NAHA, Hendriks JM, Linz D. On-demand mobile health infrastructures to allow comprehensive remote atrial fibrillation and risk factor management through teleconsultation. Clin Cardiol 2020; 43:1232-1239. [PMID: 33030259 PMCID: PMC7661648 DOI: 10.1002/clc.23469] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 01/07/2023] Open
Abstract
Background Although novel teleconsultation solutions can deliver remote situations that are relatively similar to face‐to‐face interaction, remote assessment of heart rate and rhythm as well as risk factors remains challenging in patients with atrial fibrillation (AF). Hypothesis. Mobile health (mHealth) solutions can support remote AF management. Methods Herein, we discuss available mHealth tools and strategies on how to incorporate the remote assessment of heart rate, rhythm and risk factors to allow comprehensive AF management through teleconsultation. Results Particularly, in the light of the coronavirus disease 2019 (COVID‐19) pandemic, there is decreased capacity to see patients in the outpatient clinic and mHealth has become an important component of many AF outpatient clinics. Several validated mHealth solutions are available for remote heart rate and rhythm monitoring as well as for risk factor assessment. mHealth technologies can be used for (semi‐)continuous longitudinal monitoring or for short‐term on‐demand monitoring, dependent on the respective requirements and clinical scenarios. As a possible solution to improve remote AF care through teleconsultation, we introduce the on‐demand TeleCheck‐AF mHealth approach that allows remote app‐based assessment of heart rate and rhythm around teleconsultations, which has been developed and implemented during the COVID‐19 pandemic in Europe. Conclusion Large scale international mHealth projects, such as TeleCheck‐AF, will provide insight into the additional value and potential limitations of mHealth strategies to remotely manage AF patients. Such mHealth infrastructures may be well suited within an integrated AF‐clinic, which may require redesign of practice and reform of health care systems.
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Affiliation(s)
| | | | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Dominique V M Verhaert
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lien Desteghe
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Heart Center Hasselt, Jessa Hospital, Hasselt, Belgium.,Department of Cardiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Martin Manninger
- Department of Cardiology, Medizinische Universität Graz, Graz, Austria
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Ron Pisters
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Martin Hemels
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Laurent Pison
- Department of Cardiology, Hospital East Limburg, Genk, Belgium
| | - Afzal Sohaib
- Department of Cardiology, St Bartholomew's Hospital, Bart's Health NHS Trust, London, UK.,Department of Cardiology, King George Hospital, London, UK
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Petra Wijtvliet
- Department of Cardiology, Martini Hospital, Groningen, The Netherlands
| | - Robert Tieleman
- Department of Cardiology, Martini Hospital, Groningen, The Netherlands
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| | - Emma Svennberg
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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24
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Linz D, van der Velden RMJ, Gawalko M, Hermans ANL, Pluymaekers NAHA, Hendriks JM. Remote management and education in patients with cardiovascular conditions during COVID-19 and beyond. Int J Cardiol Heart Vasc 2020; 30:100646. [PMID: 32984496 PMCID: PMC7505565 DOI: 10.1016/j.ijcha.2020.100646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Rachel M J van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, the Netherlands.,1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Astrid N L Hermans
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, the Netherlands
| | - Nikki A H A Pluymaekers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, the Netherlands
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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25
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Krzowski B, Gawalko M, Peller M, Balsam P, Lodzinski P, Grabowski M, Opolski G, Kosiuk J. P1384Radiation safety and electrophysiologists: radiation protection status. Europace 2020. [DOI: 10.1093/europace/euaa162.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Ionizing radiation is typically used during variety electrophysiological (EP) procedures, although it may contribute to deterministic effects especially for staff.
PURPOSE
The purpose of this study was to perform an analysis of EP operators’ radiation protective devices for occupational exposure.
METHODS
Data reported herein were gathered from international, multi-site, prospective, Go 4 Zero Fluoroscopy registry. The registry encompassed 25 European EP centers, and up to 5 operators from each center. The presence of operators’ X-ray protection tools was examined to determine the level of operators’ protection. Additionally, the tests included availability of measures to decrease radiation output and exposure control measures. Finally, the analysis of correlation between the X-ray protection and degree of operators’ experience (<5, 5-15,>15 years) as well as number of procedures performed per month (1-9, 10-19, 20-39, >40 procedures/month) was performed.
RESULTS
Our analysis included 95 operators (median age: 39 years, 85% of male, median training time: 5 years). The whole study group performed annually medical examinations due to radiation exposure and 56% of them received dosimetry reports once a month, 5% - once every 3 months, and 39% - once a year. Irrespectively of experience or number of performed procedures the most frequently used X-ray protection tools (used by >80% of group) were lead apron, thyroid shields, screen below the table, glass in the lab, and least often (used by < 6% of group) – protective gloves and cabin. The most often exposure control measures used were chest (95%) followed by collar (31%), ring (24%) and eye (7%) dosimeters. The inverse correlation between level of experience and measures to decrease radiation output was observed (collimation: 84%, 80% and 78%; minimizing the tube-to intensifier distance: 100%, 93% and 91% of operators with <5, 5-15 and >15 years of experience, respectively). There were not observed differences between type of radiation protection equipment and operators’ level of experience or number of procedures. Additionally, there were no differences between male and female operators regarding protective equipment, expect eyeglasses or cabin that were more often used by men. Operators who were protected by >4 X-ray protection tools were exposed for higher radiation levels as compared to those protected by <4 X-ray protection tools (median [IQR] radiation exposure: 0.6 [0.2-1.1] vs 0.2 [0.1-0.2] mSv per month, p < 0.0001; 1.1 [0.1-12.0] vs 0.5 [0.1-1.1] mSv per year, p < 0.0001). There were no differences between the type of (universitary vs non-universitary) or institution’s localization (Eastern vs Central vs Western Europe) and used protective equipment.
CONCLUSIONS
Both proper radiation protective equipment, and regular medical examination due to professional exposure are mandatory to reduce radiation exposure in practice.
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Affiliation(s)
- B Krzowski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - M Gawalko
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - M Peller
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - P Balsam
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - P Lodzinski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - M Grabowski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - G Opolski
- Medical University of Warsaw, 1st Department of Cardiology, Warsaw, Poland
| | - J Kosiuk
- Heart Center of Leipzig, Electrophysiology Department, Leipzig, Germany
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