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Wearable technologies and the potential to help support AFib detection

The following article is sponsored by Bristol Myers Squibb and Pfizer.

 

By the end of this decade, the prevalence of Atrial Fibrillation (AFib), the most common type of irregular heartbeat,1 is projected to increase from approximately 9.1 million in 2022 to about 12.1 million cases by 2030 in the U.S. as the population ages.2  

image of a woman checking her wearable wrist monitor

Patients with AFib have approximately five times greater risk of stroke than those who do not have AFib.3 With this in mind, there has been a growing trend in the use of consumer wearables as another opportunity to aid in the detection of AFib.4 These devices are being evaluated and utilized across the healthcare spectrum following clearances from regulatory bodies in the United States and other countries around the world.5

Dr. Jeff Healey

Dr. Jeff Healey

In the following interview, Dr. Jeff Healey, Director of Cardiology, Yusuf Chair in Cardiology and Professor of Medicine at McMaster University in Hamilton, Ontario, on behalf of the BMS/Pfizer Alliance, provides insight on how wearable technology may contribute to the detection of irregular heart rhythms like AFib, the importance of early detection and diagnosis of AFib, and the potential implications of wearables for patients and their care teams. Dr. Healey is a leading expert on using consumer wearables to support AFib detection, also serving as an investigator for numerous studies evaluating their potential. 

 

AFib isn’t always easy to find or diagnose.6 Can you tell us about that challenge and the risks of AFib going undiagnosed? 

Irregular heart rhythms like AFib can be tricky to diagnose in some individuals.6 AFib can be asymptomatic or have symptoms such as fatigue or shortness of breath.1 Physicians cannot always rely solely on symptoms such as palpitations or racing of the heart, as these symptoms can be transient.7 In many cases AFib presents as paroxysmal, or in recurrent brief episodes.4 In my experience, by the time some patients see their physician, the arrhythmia has stopped. If someone does present with symptoms, however, it can still be challenging to secure an ECG recording of AFib due to its paroxysmal nature.4 In many cases, symptoms start and then stop without intervention, contributing to some patients going undiagnosed for months or even years.

These are important factors to take into consideration because AFib is the most common cardiac rhythm disturbance and is projected to continue to grow in prevalence.1,2 

The increased risk of AFib-related stroke highlights the need for accurate and timely AFib detection. Timely diagnosis and intervention can help reduce stroke risk, making early detection in at-risk patients critical.7 Putting these devices in the hands of patients–in the form of wearables and smart phones supported by ECG and PPG technology–may help initial detection.

 

What are consumer wearables? What is your experience with wearables?

Consumer wearables are smart-devices that allow patients to monitor and capture biometrics such as heart rate and rhythm.4 These devices offer two methods for monitoring heart rate and rhythm – photoplethysmograph (PPG) and electrocardiograph (ECG).4 The U.S. Food and Drug Administration (FDA) has cleared a variety of devices that can be used wirelessly with frequent monitoring to help patients track heart rate and rhythm.4,5 These wearable devices–including rings, wristbands, and watches–can connect with the user’s smartphone.4 These devices designed to monitor heart rate and rhythm, have gone through regulatory clearance processes and are approved for marketed use.4 In fact, many wearables have shown the potential for aiding in early AFib detection.4 After receiving a notification from their wearable device, patients can follow up with and receive appropriate testing from their physician. 

From my perspective, the use of these technologies can be empowering for patients by allowing them to take a more active role in the management of their heart health.7 Physicians have also seen these devices provide valuable data in practice as they may detect an irregular heart rhythm that may not otherwise be captured in the office.4 Oftentimes, individuals seek out these devices and then approach their physicians with device-detected irregularities.4 Physicians can then order appropriate diagnostic evaluations, which can provide additional information to support a potential diagnosis. Combined with physician support and testing, consumer wearables can support AFib detection in at-risk patients.

 

What value can data from wearables provide to patients and their providers? 

Consumer wearables and the data they provide can help patients play an active role in their healthcare experience day-to-day, and these technologies continue to evolve.7 

Devices that frequently monitor heart rate and rhythm provide healthcare providers with data to recognize irregularities that could be AFib, potentially leading to early detection.7 For intermittent recordings, consumer wearables can be useful for identifying infrequent, symptomatic or asymptomatic episodes of AFib.7 Even though physicians conduct ambulatory monitoring, sometimes episodes of AFib are not captured by recordings in the office.4 With wearables, however, frequent monitoring can help to identify heartbeat irregularities by the device algorithms.4 These recordings can be useful as they can track individuals when they are active or at rest in real-time, with some even having longer battery life to capture recordings during sleep.7

The data produced by wearables can be beneficial for patients with existing risk factors.7 With these devices patients can actively monitor their heart rate and rhythm.7 

Patients can then share device alerts and data with their physician and the care team, playing an active role in their heart health.7

 

How do you see further advancements in technology impacting AFib detection going forward?

The evolution and impact of this technology in practice will ultimately depend on emerging evidence from clinical trials. While data from wearable devices cannot formally diagnose AFib, it can support patient-physician conversations. 

With these emerging technologies, questions still remain, particularly around best practices related to AFib screening recommendations for older individuals with underlying health issues. The 2022 U.S. Preventive Services Task Force (USPSTF) guidance concludes that, for asymptomatic adults 50 years or older, there is currently a lack of evidence, and the balance of benefits and harms of screening for AFib with ECG or additional screening methods such as blood pressure cuffs, pulse oximeters, and consumer devices in asymptomatic adults cannot be determined at this time.8

 

What is the next step after a patient receives a notification about an irregular heart rhythm?

After receiving this type of notification, a patient should connect with their healthcare provider so they can further evaluate the situation and determine the need to perform additional testing.4 It is especially important that individuals using these devices have access to a provider for evaluation and timely action, as needed.

Patients should have open communication with their providers so they can address any questions or concerns they have while using these devices. 

 

If healthcare professionals and clinicians would like to adopt wearables into their practice, what advice would you give them?

Regardless of whether or not clinicians recommend using wearables in practice, individuals are increasingly likely to purchase these devices for personal use. It is important that physicians educate themselves on the devices that are available and their data outputs so they can develop their own approach and engage appropriately with patients. 

Medical literature, professional society guidelines, and government groups, such as the 2022 USPSTF, offer multiple perspectives on the role of screenings and use of wearables technologies. 

 

What might discourage healthcare professionals, clinicians, and the broader care team from incorporating wearables into their practice?

Based on my experience, initially, there was some wariness around non-physician- and non-nurse-based healthcare provision. However, this perspective has progressed over the last few decades as patient access to technology and health literacy has improved, though this access still comes with financial limitations in many parts of the country. I recommend that today’s physicians acknowledge that the use of wearable devices is continuing to increase. It is also important that healthcare providers have an understanding of the breadth of wearables on the market and when it is appropriate to recommend these devices to patients. While more research is needed, these technologies have empowered many patients to participate in their healthcare and have the potential to help support early AFib detection.  

Physicians can consider establishing protocols to avoid being overwhelmed with patient data from wearables while engaging in these conversations. As the role of wearables continues to evolve, providers should have open conversations with their patients on what is reasonable when it comes to reviewing the volume of information these devices detect and when to contact their care team.  

 

How do you think AFib detection will evolve over the next 5 to 10 years?

In the coming years, I think we are likely to see more engagement with wearable technology from patients and healthcare providers. We will also have a better understanding of the impact these devices can have. I also expect that we will see some of the current large trials of AFib screening read out, and we may see a change in AFib screening recommendations.

Predicting the future is challenging, but I am optimistic that there will be groups of individuals where screening may ultimately be recommended, and consumer wearables will be more widely adopted driven by age and underlying risk factors.

__________________________________

References    

[1] Atrial fibrillation. Centers for Disease Control and Prevention (CDC). Accessed December 8, 2020. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm

[2] Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112:1142–1147. doi: 10.1016/j.amjcard.2013.05.063.

[3] Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991;22(8):983-988.

[4] Ding EY, Marcus GM, McManus DD. Emerging technologies for identifying atrial fibrillation. Circ Res. 2020;127:128–142.

[5] Varma N, Marrouche NF, Aguinaga L, et al. HRS/EHRA/APHRS/LAHRS/ACC/AHA worldwide practice update for telehealth and arrhythmia monitoring during and after the pandemic. J Am Coll Cardiol. 2020;76(11):1363-1374. doi: 10.1016/j.jacc.2020.06.019

[6] Stahrenberg R, Weber-Krüger M, Seegers J, Edelmann F, Lahno R, Haase B, Mende M, Wohlfahrt J, Kermer P, Vollmann D, Hasenfuss G, Gröschel K, Wachter R. Enhanced detection of paroxysmal atrial fibrillation by early and prolonged continuous holter monitoring in patients with cerebral ischemia presenting in sinus rhythm. Stroke. 2010 Dec;41(12):2884-8. doi: 10.1161/STROKEAHA.110.591958. Epub 2010 Oct 21. PMID: 20966415.

[7] Elaine Y. Wan, Hamid Ghanbari, Nazem Akoum, Zachi Itzhak Attia, Samuel J. Asirvatham, Eugene H. Chung, Lilas Dagher, Sana M. Al-Khatib, G. Stuart Mendenhall, David D. McManus, Rajeev K. Pathak, Rod S. Passman, Nicholas S. Peters, David S. Schwartzman, Emma Svennberg, Khaldoun G. Tarakji, Mintu P. Turakhia, Anthony Trela, Hirad Yarmohammadi, Nassir F. Marrouche, HRS White Paper on Clinical Utilization of Digital Health Technology,Volume 2, Issue 4, 2021, Pages 196-211, ISSN 2666-6936, https://doi.org/10.1016/j.cvdhj.2021.07.001.

[8] US Preventive Services Task Force. Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(4):360–367. doi:10.1001/jama.2021.23732

 

CV-US-2200387 8/22

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