Wearables offer “great potential” in AF screening but physicians cautious over mass use

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Guiseppe Boriani

Consumer wearables offer a great potential for the screening of atrial fibrillation (AF), however two thirds of healthcare professionals admit to concerns over mass consumer-initiated testing for AF.

These are the findings of a survey published in the European Journal of Internal Medicine in December, exploring the role of consumer wearables in AF screening and assessing physician attitudes towards their use in clinical practice.

The paper authored by Guiseppe Boriani (University of Modena and Reggio Emilia, Modena, Italy) and colleagues notes that new tools are emerging for the detection of AF, using a variety of technologies based upon plethysmography or single-lead electrocardiogram (ECG) also implemented in wearables including smartphones and watches.

The debate on benefits, efficacy and limitations of screening initiatives prompted the authors to propose an online survey to explore current views, current practice and related organizational issues on AF screening using the most advanced technologies implemented in watches, smartphones and other devices, they add.

Questions in the AF SCREEN survey were designed to establish how healthcare professionals perceive the significance of AF screening through wearables, in what settings it may be considered as appropriate and useful, what is the current status of referral and what are the potential developments in the field. In total, 588 healthcare professionals responded to the survey.

The first question of the survey analysed if healthcare professionals ever advise use by patients of any of the available wearable devices or apps for AF detection, with responses indicating that that 43% of respondents choose not to suggest the use of these devices, while 57% of respondents at least sometimes advice their use.

The study authors note that there were differences between groups of healthcare professionals in these responses, with between 62–67% of GPs, neurologists and other specialist physicians never advising use of these devices for AF detection compared to 43% of general cardiologists, and only 25% of electrophysiologists.

Question two focused on scenarios where wearable devices could have an important role to play in AF detection, stressing the role of wearables, devices and apps to search for AF in patients with palpitations or other symptoms but no previous detected AF (supported by 75% of respondents), as well as for searching for AF post-stroke and post-AF ablation with recurrent symptoms (supported by 48–50% of respondents).

Electrophysiologists were the most likely to advise use of the devices in patients with symptoms (86%). With regard to the potential use for screening, according to 44–46% of respondents there is an important role of this technology for subjects aged > 65 years or in patients with risk factors.

The potential disadvantages of mass community screening using wearable devices and apps were reported as an anxiety by around 65% of respondents. Additionally, for 39% of respondents the risk of bleeding due to anticoagulant prescriptions after a positive test, in light of a still unproven benefit for AF detected this way, represents a disadvantage of screening. Conversely, for around 20% of respondents no important disadvantages for mass community screening are currently perceived at an individual level.

Summarising their findings, Boriani and colleagues note: “There is a great potential for appropriate use of consumer-facing wearables/apps for AF screening, but the current consumer-led use following direct marketing suggests the need for identification of appropriate targets, organisation of referral and appropriate patient information on the purpose and implications of AF detection. Greater dialogue between stakeholders is required to ensure there is value for the healthcare process through appropriate use of these new diagnostic resources.”

The gestalt of majority of the 588 respondents to the survey was that these apps and devices which are directly marketed to consumers are not yet ready for mass screening for AF, the study’s authors said.


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