Cost Saving Potential of an Early Detection of Atrial Fibrillation in Patients after ICD Implantation

Reinhold, Thomas; Belke, Roberto; Hauser, Tino; Grebmer, Christian; Lennerz, Carsten; Semmler, Verena; Kolb, Christof

doi:10.1155/2018/3417643

Cited by 5 publications

(12 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In fact, recent US data point to an extremely wide variability in OAC prescription driven by ICD-detected subclinical AT/AF that showed a close relationship with increased arrhythmia duration. 20 Though this findings highlights the gap in our current knowledge, our data are consistent showing potential underuse of OAC in single-chamber patients because of the impossibility to detect and quantify asymptomatic or subclinical atrial arrhythmias, which increase the risk of thromboembolic events. 21 On the basis of these considerations, our analysis supports published data which estimated clinical and economic benefits by using singlelead ICD with atrial sensing capabilities.…”

Section: Incidence and Clinical Impact Of Ahresupporting

confidence: 78%

“…The incidence of new OAC prescription tended to be higher in the DX than in the VR group (6.3% vs 3.6%; P = .184) and showed a positive correlation with arrhythmic episode duration. In fact, recent US data point to an extremely wide variability in OAC prescription driven by ICD‐detected subclinical AT/AF that showed a close relationship with increased arrhythmia duration 20 . Though this findings highlights the gap in our current knowledge, our data are consistent showing potential underuse of OAC in single‐chamber patients because of the impossibility to detect and quantify asymptomatic or subclinical atrial arrhythmias, which increase the risk of thromboembolic events 21 .…”

Section: Discussionsupporting

confidence: 67%

See 1 more Smart Citation

The role of atrial sensing for new‐onset atrial arrhythmias diagnosis and management in single‐chamber implantable cardioverter‐defibrillator recipients: Results from the THINGS registry

Biffi

Iori²,

Maria

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction Atrial tachycardia/fibrillation (AT/AF) episodes are common in implantable cardioverter‐defibrillator (ICD) recipients and can be undetected by standard single‐chamber devices. This study aims to explore whether a single‐lead ICD with an atrial dipole (ICD DX; BIOTRONIK SE & Co, Berlin, Germany) could improve the AT/AF diagnosis and management as compared to standard ICD (ICD VR). Methods and Results We selected patients without AT/AF history from the THINGS registry which included consecutive patients implanted with ICD for standard indications. The ICD VR and the ICD DX groups included 236 (62.8%) and 140 (37.2%) patients, respectively, and had no significant differences in baseline characteristics. During a median follow‐up of 27 months, there were 7 AT/AF diagnoses in the ICD VR and 18 in the ICD DX group. The 2‐year incidence of AT/AF diagnosis was 3.6% (95% confidence interval [CI]: 1.6%‐9.6%) for the ICD VR and 11.4% (95% CI: 6.8%‐18.9%) for the ICD DX group (adjusted hazard ratio [HR]: 3.85 [95% CI: 1.58‐9.41]; P = .003). Initiation of oral anticoagulation (OAC) due to AT/AF diagnosis was reported in 15 patients. The 2‐year incidence of OAC onset was 3.6% (95% CI: 1.6%‐7.8%) for the ICD VR and 6.3% (95% CI: 3.0%‐12.7%) for ICD DX group (adjusted HR: 1.99 [95% CI: 0.72‐5.56]; P = .184). Conclusion We observed that atrial sensing capability in single‐chamber ICD patients without evidence of atrial arrhythmias at implant is associated with a greater likelihood of detecting AT/AF episodes. The management of these diagnosed arrhythmias often led to clinical interventions, mainly represented by initiation of OAC therapy.

show abstract

Section: Incidence and Clinical Impact Of Ahresupporting

confidence: 78%

Section: Discussionsupporting

confidence: 67%

The role of atrial sensing for new‐onset atrial arrhythmias diagnosis and management in single‐chamber implantable cardioverter‐defibrillator recipients: Results from the THINGS registry

Biffi

Iori²,

Maria

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…The difference in costs between treated and untreated atrial fibrillation is significant. A stroke survivor with atrial fibrillation receiving oral anticoagulation costs €17,518, and the cost for a stroke survivor with atrial fibrillation not receiving oral anticoagulation is €19,143 [8]. Furthermore, there are several studies confirming the cost-effectiveness of screening for atrial fibrillation [9-12].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of mHealth Devices for Atrial Fibrillation Screening: Systematic Review

Giebel¹,

Gissel²

2019

JMIR Mhealth Uhealth

100

View full text Add to dashboard Cite

Background Mobile health (mHealth) devices can be used for the diagnosis of atrial fibrillation. Early diagnosis allows better treatment and prevention of secondary diseases like stroke. Although there are many different mHealth devices to screen for atrial fibrillation, their accuracy varies due to different technological approaches. Objective We aimed to systematically review available studies that assessed the accuracy of mHealth devices in screening for atrial fibrillation. The goal of this review was to provide a comprehensive overview of available technologies, specific characteristics, and accuracy of all relevant studies. Methods PubMed and Web of Science databases were searched from January 2014 until January 2019. Our systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses. We restricted the search by year of publication, language, noninvasive methods, and focus on diagnosis of atrial fibrillation. Articles not including information about the accuracy of devices were excluded. Results We found 467 relevant studies. After removing duplicates and excluding ineligible records, 22 studies were included. The accuracy of mHealth devices varied among different technologies, their application settings, and study populations. We described and summarized the eligible studies. Conclusions Our systematic review identifies different technologies for screening for atrial fibrillation with mHealth devices. A specific technology’s suitability depends on the underlying form of atrial fibrillation to be diagnosed. With the suitable use of mHealth, early diagnosis and treatment of atrial fibrillation are possible. Successful application of mHealth technologies could contribute to significantly reducing the cost of illness of atrial fibrillation.

show abstract

“…A Markov Model, a practical tool for medical decision making [ 5 ], was developed to assess the health economic impact of wrist-worn PPG mHealth devices in the diagnosis of AF. A model previously published by Reinhold et al who compared implantable cardioverter-defibrillators was adapted [ 6 ]. A Monte Carlo simulation was conducted based on a developed state-transition model.…”

Section: Methodsmentioning

confidence: 99%

“…An interpolation and an extrapolation were made to receive period-specific costs ( Figure 3 and Table 2 ). The costs for major bleeding (€1995) were directly derived from the study of Reinhold et al [ 6 ]. The present value was calculated using a discount rate of 3% per year.…”

Section: Methodsmentioning

confidence: 99%

Use of mHealth Devices to Screen for Atrial Fibrillation: Cost-Effectiveness Analysis

Giebel¹

2020

JMIR Mhealth Uhealth

View full text Add to dashboard Cite

Background With an estimated prevalence of around 3% and an about 2.5-fold increased risk of stroke, atrial fibrillation (AF) is a serious threat for patients and a high economic burden for health care systems all over the world. Patients with AF could benefit from screening through mobile health (mHealth) devices. Thus, an early diagnosis is possible with mHealth devices, and the risk for stroke can be markedly reduced by using anticoagulation therapy. Objective The aim of this work was to assess the cost-effectiveness of algorithm-based screening for AF with the aid of photoplethysmography wrist-worn mHealth devices. Even if prevented strokes and prevented deaths from stroke are the most relevant patient outcomes, direct costs were defined as the primary outcome. Methods A Monte Carlo simulation was conducted based on a developed state-transition model; 30,000 patients for each CHA2DS2-VASc (Congestive heart failure, Hypertension, Age≥75 years, Diabetes mellitus, Stroke, Vascular disease, Age 65-74 years, Sex category [female]) score from 1 to 9 were simulated. The first simulation served to estimate the economic burden of AF without the use of mHealth devices. The second simulation served to simulate the economic burden of AF with the use of mHealth devices. Afterwards, the groups were compared in terms of costs, prevented strokes, and deaths from strokes. Results The CHA2DS2-VASc score as well as the electrocardiography (ECG) confirmation rate had the biggest impact on costs as well as number of strokes. The higher the risk score, the lower were the costs per prevented stroke. Higher ECG confirmation rates intensified this effect. The effect was not seen in groups with lower risk scores. Over 10 years, the use of mHealth (assuming a 75% ECG confirmation rate) resulted in additional costs (€1=US $1.12) of €441, €567, €536, €520, €606, €625, €623, €692, and €847 per patient for a CHA2DS2-VASc score of 1 to 9, respectively. The number of prevented strokes tended to be higher in groups with high risk for stroke. Higher ECG confirmation rates led to higher numbers of prevented strokes. The use of mHealth (assuming a 75% ECG confirmation rate) resulted in 25 (7), –68 (–54), 98 (–5), 266 (182), 346 (271), 642 (440), 722 (599), 1111 (815), and 1116 (928) prevented strokes (fatal) for CHA2DS2-VASc score of 1 to 9, respectively. Higher device accuracy in terms of sensitivity led to even more prevented fatal strokes. Conclusions The use of mHealth devices to screen for AF leads to increased costs but also a reduction in the incidence of stroke. In particular, in patients with high CHA2DS2-VASc scores, the risk for stroke and death from stroke can be markedly reduced.

show abstract

Cost Saving Potential of an Early Detection of Atrial Fibrillation in Patients after ICD Implantation

Cited by 5 publications

References 40 publications

The role of atrial sensing for new‐onset atrial arrhythmias diagnosis and management in single‐chamber implantable cardioverter‐defibrillator recipients: Results from the THINGS registry

The role of atrial sensing for new‐onset atrial arrhythmias diagnosis and management in single‐chamber implantable cardioverter‐defibrillator recipients: Results from the THINGS registry

Accuracy of mHealth Devices for Atrial Fibrillation Screening: Systematic Review

Use of mHealth Devices to Screen for Atrial Fibrillation: Cost-Effectiveness Analysis

Contact Info

Product

Resources

About