How New Screening Technology Has Influenced Atrial Fibrillation Screening

Emma Svennberg, MD, PhD

In recent years, the advancement of wearable technology and health/performance-related heart monitoring systems have provided clinicians an opportunity to bridge the gap between consumers and proactive care for atrial fibrillation risk.

Namely, a common yet under-diagnosed condition like atrial fibrillation (AF)—linked to greater major adverse cardiovascular events (MACE) and even dementia—could be better addressed with the bevy of data coming available from consumer technology.

In a virtual presentation at the European Society of Cardiology (ESC) 2020 Congress this weekend, Emma Svennberg, MD, PhD, of the Karolinska University Hospital in Sweden, discussed the progress made in this venture and how it pertains to a greater question—and the name of her session: “Will digital health finally solve the problem of asymptomatic atrial fibrillation screening?”

Svennberg started with discussing the burden of AF in and out of comorbid cardiovascular conditions: about 10% of all ischemic stroke patients have undiagnosed AF; its symptoms correlate with worse clinical outcomes, while initially treated cases are more manageable.

“With all these facts, it’s of course tempting to think that screening for atrial fibrillation would be beneficial,” Svennberg said. “And it might be, but we still don’t have any trials with hard clinical outcomes, which is probably there is still controversy surrounding atrial fibrillation screening.”

The digital technology now available to both clinicians and consumers for screening AF is varied and growing: pulse palpation, blood pressure monitors, smartphone photoplethysmography (PPG), and diverse electrocardiogram (ECG) platforms—handheld, smartphone, and smartwatch, to name the prominent items.

Svennberg advised ECG devices be preferred for immediately validated AF diagnoses; the former 3 would require ECG confirmation regardless.

All these new devices and unprecedented technology—including facial recognition software with the capability to detect AF from recorded video—have given clinicians more capability to monitor for AF.

The problem, she noted, is that there is still an uncertainty of treatment strategies in AF-observed cases from prolong ECG monitoring in the new devices.

In reviewing some of the most prominent data to come from the relatively young trend of AF detection assessment via new devices, Svennberg observed consistent trends across a trio of outcomes.

The STROKESTOP study, involving 28,000-plus patients aged 75-76 years old, showed that of 7173 to attend a screening clinic, 218 (3%) were diagnosed with new AF.

Another trial using continuous monitoring screening via patch ECG among elderly patients observed 4% new AF cases among 100,000-plus individuals.

And the APPLE HEART trial, involving 400,000-plus individuals (mean age, 41) monitored with non-diagnostic PPG devices in their smartwatch, resulted in just 153 (.04%) new AF cases.

“When we look at various screening studies, we can see the population age is of significant importance,” Svennberg explained.

She explained that technology like artificial intelligence (AI) models may help to inform efforts in project AF risk in patients, particularly among those to have undergone sinus rhythm screening.

And what technology-based studies can do to benefit the asymptomatic AF model is in setting a prioritization of risk screening—based on individual’s age, stroke risk or occurrence, and stratified by advancing methods of AF screening.

“I think that possibly we can see that digital health can provide at least some links in the chain toward the solution,” Svennberg said.

The question needed to be answered in the next generation of AF screening device assessments should pertain to care implicative of actual AF diagnosis: will screening reduce future risk of ischemic stroke and dementia?

“We will have to wait,” she concluded.