Screening for Atrial Fibrillation and the Role of Digital Health Technologies

Abstract

Atrial fibrillation is the commonest clinical arrhythmia and a leading cause of hospital admission, morbidity and mortality. New digital health technologies are now allowing patients and the general population to identify heart rhythm abnormalities before any encounter with a medical professional. This chapter will include an overview of the prevalence of atrial fibrillation and explore the current recommendations on methods for arrhythmia screening. We discuss different risk factors as well as physiological and structural markers for atrial fibrillation onset. We explore in detail the application of novel digital health technologies such as wearables, watches and mobile devices which may have an impact on screening detection rates. The article concludes with a discussion about how to manage patients with screen detected atrial fibrillation.

Diagnostic accuracy of digital technologies compared with 12-lead ECG in the diagnosis of atrial fibrillation in adults: A protocol for a systematic review

“…To date, a number of digital technologies have been developed that can be used to diagnose AF, with the added benefits of being portable, patient-friendly and cost effective [ 10 ]. Such devices could be particularly beneficial in diagnosing AF in at-risk populations in LMICs where the lack of healthcare access and diagnostic equipment are a known barrier for early AF diagnosis [ 31 ].…”

“…Digital health technologies to improve the accuracy and diagnostic rate of AF have rapidly advanced in the last decade [ 6 , 7 ]. Examples include smart watches, smart belts, single lead mobile based electrocardiogram (ECG), portable Holter monitoring devices, modified blood pressure monitors and photoplethysmography (PPG) [ 7 ].…”

“…Digital health technologies to improve the accuracy and diagnostic rate of AF have rapidly advanced in the last decade [ 6 , 7 ]. Examples include smart watches, smart belts, single lead mobile based electrocardiogram (ECG), portable Holter monitoring devices, modified blood pressure monitors and photoplethysmography (PPG) [ 7 ]. These technological advancements are often minimally-intrusive and enable self-testing and ad-hoc long-term monitoring [ 6 ]; thus, improving early diagnosis and self-monitoring by mitigating barriers of inaccessibility to and non-attendance at healthcare facilities.…”

“…Advanced devices allow for the transfer of physiological parameters and patient-reported symptoms directly from smartphone applications to healthcare providers, reducing the number of healthcare visits necessary; thus, reducing costs on the patient and healthcare system [ 6 , 8 ]. Mobile connectivity has exponentially increased globally over the last 20 years, including in LMICs where now more than half the population use mobile internet [ 9 , 10 ]. As the growth of mobile connectivity continues to rise, the benefits of using digital technologies will become increasingly notable in LMICs where AF burden is increasing the most [ 11 ].…”

Cryptogenic Stroke: Cardiac Rhythm Monitoring as An Indispensable Screening Modality

“…Furthermore, traditional monitors may be ineffective in some cases as duration and time of wear may be incongruent with symptoms. 16 Thus, digital health tools will aid more adhoc monitoring. However, the disadvantages that come with these tools are false-positive episodes of AF due to substantial electrical or motion artifact, misclassified rhythms, and unavailability of other arrhythmias classification.…”