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Patch-based AF screening boosts diagnosis rate

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Proof needed for clinical value of AF screening

The results from mSToPS provide strong support for the use of continuous rhythm monitoring to screen for atrial fibrillation (AF) in at-risk populations, showing a detection rate as high as 5.1% after 4 months in the per protocol analysis. Screening people using a wearable ECG patch for a 2-week interval appears to have detected a substantial proportion of patients who might otherwise be detected with more inconvenient, invasive, costly, or longer monitoring approaches.

Existing epidemiologic and outcomes data support interventions for risk factors and symptoms of AF early in the disease process, but clinical trials demonstrating improved cardiovascular outcomes such as reduced stroke occurrence will be necessary to take action and screen for AF at the population level. Before the findings of mSToPS can be incorporated into clinical practice, clinicians need to consider two major questions about structured AF screening: Does earlier or more sensitive detection of AF improve clinical outcomes? And is this approach cost effective?

Benjamin A. Steinberg, MD , an electrophysiologist at the University of Utah, Salt Lake City, and Jonathan P. Piccini, MD , an electrophysiologist at Duke University, Durham, N.C., made these comments in an accompanying editorial ( JAMA. 2018 Jul 10;320[2]:139-41 ). Dr. Steinberg reported receiving research grants or personal fees from Boston Scientific, Biosense Webster, and Janssen. Dr. Piccini reported consulting with Allergen, Bayer, Johnson & Johnson, Medtronic, Sanofi, and Phillips, and receiving research funding from Abbott, ARCA Biopharma, Boston Scientific, Gilead, Janssen, and Verily.



Of the 1,738 people who wore at least one patch for more than 30 minutes, 40 (2%) had skin irritation, 32 stopped using the patch prematurely because of irritation, and 2 people sought medical treatment for their irritation, which involved topical treatment.

mSToPS was funded by Janssen. Dr. Steinhubl has received research funding from Janssen, DynoSense, EasyG, Spry Health, and Striiv.

SOURCE: Steinhubl SR et al. JAMA. 2018 July 10;320[2]:149-55.

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