Feasibility of Atrial Fibrillation Screening With Mobile Health Technologies at Pharmacies

Abstract

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Thus, the aim of our study was to evaluate the smartphone-based electrocardiogram (ECG) recordings aimed at AF screening at Polish pharmacies. Methods: Prospective AF screening among patients aged ≥65 years was conducted at 10 pharmacies using Kardia Mobile with a dedicated application (Kardia app). Prior AF was a study exclusion criterion. CHA2DS2-VASc score (congestive heart failure, hypertension, age, diabetes mellitus, previous stroke/transient ischemic attack, female sex, and vascular disease) has been collected from every patient. A single-lead ECG has been acquired by the placement of fingers from each hand on the pads. Kardia app diagnosis has been evaluated by the cardiologist. Results: A total of 525 ECGs were performed. Kardia app diagnosis was provided in 490 cases. In 437 (89.18%) cases, it was “normal” rhythm, in 17 (3.47%) recordings “possible AF,” in 23 (4.69%) ECGs “unreadable,” and in 13 (2.65%) “unclassified”. After the cardiologist reevaluation, the new AF was identified in 7 (1.33%) patients. Sensitivity and specificity of Kardia app in detecting AF was 100% (95% confidence interval [CI]: 71.5%-100%) and 98.7% (95% CI: 97.3%-99.5%), respectively. The positive predictive value was 64.7% (95% CI: 38.3%-85.7%) and the negative predictive value was 100% (95% CI: 99.2%-100%). CHA2DS2-VASc score was 2.14 ± 0.69 for those with new AF and 3.33 ± 1.26 in the non-AF group. Conclusion: Kardia app is capable of fast screening and detecting AF with high sensitivity and specificity. The possible diagnosis of AF deserves additional cardiological evaluation. The results obtained in patients with low CHA2DS2-VASc score and “silent” AF confirm the importance of routine AF screening. Cardiovascular screening with the use of mobile health technology is feasible at pharmacies.

Performance of a Mobile Single-Lead Electrocardiogram Technology for Atrial Fibrillation Screening in a Semirural African Population: Insights From “The Heart of Ethiopia: Focus on Atrial Fibrillation” (TEFF-AF) Study

“…However, the device also returns other results of too short, tachycardia, bradycardia, unreadable, or unclassified. Notably, screening studies using the KardiaMobile device, including the Heart Rhythm Society/American College of Physicians AF Screening and Education Initiative, have encountered between 5% and 28% of unclassified ECG recordings [8][9][10][11][12]. The high frequency of unclassified tracings may limit the effective utility of this device for AF screening.…”

Costs of Stroke and Incidence of First Diagnosis of Atrial Fibrillation at Time of Stroke. Neurology Ward Hospital Poznań, Poland 2018

“…Stroke prevalence, the increasing number of affected patients and rapidly aging societies [5,7,[10][11][12] contribute to the fact that stroke is characterized by a significant economic burden [1,5,11,13]. In the study published in 2020 by Puciarelli et al, the direct cost for stroke in Europe was calculated at EUR 16 billion, whereas in the US it was USD 23.6 billion [6].…”

“…Apart from common risk factors (e.g., diabetes, hypertension and smoking) for stroke [8], atrial fibrillation (AF) is also a major cause of ischemic stroke and is associated with about one third of all strokes [10,14]. If AF, however, is diagnosed early and anticoagulant treatment is introduced simultaneously, 64% of AF-related strokes might be prevented [15,16].…”

“…Despite a decrease in stroke mortality in western countries [8] and progress in stroke prevention, there is still space for improvements which may contribute to further reduction of stroke-related costs [4]. One of the most interesting AF detection and stroke prevention methods is mobile health technology based on mobile and wireless devices such as smartphones with a dedicated application [10,15,17]. Although the European Society of Cardiology (ESC) recommends opportunistic AF screening among patients aged ≥ 65 years, this is not routinely performed [10,18,19].…”

“…One of the most interesting AF detection and stroke prevention methods is mobile health technology based on mobile and wireless devices such as smartphones with a dedicated application [10,15,17]. Although the European Society of Cardiology (ESC) recommends opportunistic AF screening among patients aged ≥ 65 years, this is not routinely performed [10,18,19].…”