Woman hand with Apple Watch Series 4 with ECG app

Wearables more cost-effective than ECGs for AF screening, study finds

Image credit: Prykhodov | Dreamstime

Screening individuals for atrial fibrillation (AF) using wearable devices is more cost-effective than screening using traditional methods such as electrocardiograms (ECGs) and pulse palpation, according to new research.

The study from a team at Massachusetts General Hospital (MGH) in the US reported that the use of contemporary wrist-worn wearables was also associated with a reduction in stroke incidence and could help to detect less frequent AF episodes through its ability to monitor for potentially irregular heart rhythm on a near-continuous basis.

“The proliferation of wrist-worn devices for AF detection provides a convenient option for population-wide screening, though it’s not known if their use will lead to increased costs and problems related to follow-up testing and false positives,” said Jagpreet Chhatwal, director of the MGH Institute for Technology Assessment.

“We, therefore, simulated a virtual trial comparing clinical and cost outcomes under different AF screening strategies, and showed that those using wrist-worn devices resulted in greater benefits compared to traditional modalities, and at a cost deemed affordable to the healthcare system.”

Atrial fibrillation is the most common type of heart arrhythmia, and undiagnosed AF is the leading cause of stroke. Studies have shown that population-based screening for AF could cause earlier initiation of oral anticoagulation therapy to prevent AF-related stroke, though current health system guidelines conflict.

Cardiology societies in Europe and Australia/New Zealand, for example, recommend screening using pulse palpation or ECG rhythm strips (both typically conducted in physician offices) for individuals aged 65 and over. Meanwhile, the US Preventive Services Task Force has concluded there is insufficient evidence to recommend AF screening using ECG.

In an era where more consumers are adopting wearable devices, MGH researchers tested eight screening strategies – six using wrist-worn wearables and two employing pulse palpation and ECG.

The six wrist-worn wearables included devices using two types of technology: photoplethysmography (PPG), which is the non-invasive use of a light source at the wrist to measure changes in blood volume as an indicator of the pulse, and ECG, composed of single-lead wearables that use sensors attached to the skin to detect the electrical activity of the heart.

Both technologies are often available on the same device, such as the latest iterations of the Apple Watch and Fitbit.

Using a model that simulates a 30-million-person cohort of people 65 and older, the team found the “economically preferred” strategy to be a wrist-wearable PPG, followed by a wrist-worn ECG accompanied by a clinical-grade rhythm-monitoring patch worn on the body for two weeks for confirmation.

“We believe our findings provide justification for integrating wrist-worn wearables into AF screening programs, and potentially targeting populations younger than the typically recommended age of 65 for AF screening, perhaps even as low as age 50,” said Shaan Khurshid, an electrophysiology fellow at MGH.

“The ability to use these monitoring devices over extended periods could lead to the detection of infrequent paroxysmal AF, which is otherwise very difficult for clinicians to diagnose.”

Steven Lubitz, a cardiac electrophysiologist at MGH, added: “Our study might trigger additional research to determine how healthcare professionals can best deploy wrist-worn screening to improve AF-related outcomes, such as stroke prevention.”

Research scientist Wanyi Chen suggested another potential avenue of exploration using this initial study. “If wrist-worn devices are more cost-effective, does it then make sense for insurance providers to facilitate even wider deployment by helping to defray the cost for consumers?”

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