Novel Smartphone Trial Design Collects Large-Scale AF Data Very Rapidly

SAN FRANCISCO―Large scale screening for atrial fibrillation (AF) is feasible using smartphone apps already available, according to authors of one of the largest population studies on AF ever conducted.

"Using digital technology only, we were able to reach a large population very quickly and collect clinically meaningful and actionable data, without the need for medical infrastructure,” reported lead author Tine Proesmans, MASc, of the Mobile Health Unit at Hasselt University in Belgium on May 11th at the 2019 Heart Rhythm Society meeting.

More than 60 000 participants from the general population in Belgium were screened and enrolled using only existing communications, ie, local and national newspapers, over a 2-week period. All participants gained access to the approved smartphone app (FibriCheck® by Qompium) by scanning a code provided in the advertisements. Participants were instructed to measure heart rhythm for 8 days at regular intervals twice daily as well as when experiencing symptoms. The smartphone technology allowed for the flexibility to take measurements “anytime, anywhere, and at a fraction of the cost" of using traditional healthcare resources, Dr Proesmans emphsized.

Each event was recorded and classified as regular rhythm, possible AF, irregular rhythm or insufficient quality. During the recorded time period, 72% percent of participants had no symptoms, while 27% showed persistent AF. A total of 581 participants (73%) had paroxysmal AF, with 111 detected on the first pulse-plethysmography (PPG)-measurement. All participants received a written report with a copy of rhythm traces and a physician-based conclusion regarding their AF pattern.

Participants had an average age of 48.5 years (± 14.7 years) and the group was ~58% male. Average age of the group identified as having AF was ~62 years (± 10.9 years) and ~76% male.

Importantly, 72% of the AF participants experienced no symptoms.

An estimated 33.5 million adults are affected by AF annually. Not only did this trial demonstrate the efficacy of the AF screening modality, but it also showed how smartphone technology can be easily utilized for very low-cost screening, monitoring, and treatment applications across broad populations. "It's fascinating to see the impact that PPG technology is having on clinical practice,” Dr Proesmans observed. “Using digital tools in a very structured way enables us to outpace any other traditional methodology to screen or prescreen patients and guide them into an appropriate care pathway." The trial is continuing into phase II, where participants will be sent follow-up questionnaires to map the decision-making process of screening AF-positive participants and their physicians.

Source: Proesmans T, Verbrugge F, Vandercoort P, et al.  DIGITAL-AF II: Results From A Real-life Digital Atrial Fibrillation Screening And Outcome Registry In The General Population.