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      Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation : The mSToPS Randomized Clinical Trial

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          Abstract

          Opportunistic screening for atrial fibrillation (AF) is recommended, and improved methods of early identification could allow for the initiation of appropriate therapies to prevent the adverse health outcomes associated with AF.

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          Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation

          Julian Halcox, Kathie Wareham, Antonia Cardew … (2017)
          Asymptomatic atrial fibrillation (AF) is increasingly common in the aging population and implicated in many ischemic strokes. Earlier identification of AF with appropriate anticoagulation may decrease stroke morbidity and mortality.
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            A systematic review of validated methods for identifying atrial fibrillation using administrative data.

            S R Heckbert, Sascha Dublin, Chantel Jensen … (2011)
            The objectives of this study were to characterize the validity of algorithms to identify AF from electronic health data through a systematic review of the literature and to identify gaps needing further research. Two reviewers examined publications during 1997-2008 that identified patients with atrial fibrillation (AF) from electronic health data and provided validation information. We abstracted information including algorithm sensitivity, specificity, and positive predictive value (PPV). We reviewed 544 abstracts and 281 full-text articles, of which 18 provided validation information from 16 unique studies. Most used data from before 2000, and 10 of 16 used only inpatient data. Three studies incorporated electronic ECG data for case identification or validation. A large proportion of prevalent AF cases identified by ICD-9 code 427.31 were valid (PPV 70%-96%, median 89%). Seven studies reported algorithm sensitivity (range, 57%-95%, median 79%). One study validated an algorithm for incident AF and reported a PPV of 77%. The ICD-9 code 427.31 performed relatively well, but conclusions about algorithm validity are hindered by few recent data, use of nonrepresentative populations, and a disproportionate focus on inpatient data. An optimal contemporary algorithm would likely draw on inpatient and outpatient codes and electronic ECG data. Additional research is needed in representative, contemporary populations regarding algorithms that identify incident AF and incorporate electronic ECG data. Copyright © 2012 John Wiley & Sons, Ltd.
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              Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association

              Pamela J. McCabe, Peter A. Noseworthy, Marco V. Perez … (2018)
              Our understanding of the risk factors and complications of atrial fibrillation (AF) is based mostly on studies that have evaluated AF in a binary fashion (present or absent) and have not investigated AF burden. This scientific statement discusses the published literature and knowledge gaps related to methods of defining and measuring AF burden, the relationship of AF burden to cardiovascular and neurological outcomes, and the effect of lifestyle and risk factor modification on AF burden. Many studies examine outcomes by AF burden classified by AF type (paroxysmal versus nonparoxysmal); however, quantitatively, AF burden can be defined by longest duration, number of AF episodes during a monitoring period, and the proportion of time an individual is in AF during a monitoring period (expressed as a percentage). Current guidelines make identical recommendations for anticoagulation regardless of AF pattern or burden; however, a review of recent evidence suggests that higher AF burden is associated with higher risk of stroke. It is unclear whether the risk increases continuously or whether a threshold exists; if a threshold exists, it has not been defined. Higher burden of AF is also associated with higher prevalence and incidence of heart failure and higher risk of mortality, but not necessarily lower quality of life. A structured and comprehensive risk factor management program targeting risk factors, weight loss, and maintenance of a healthy weight appears to be effective in reducing AF burden. Despite this growing understanding of AF burden, research is needed into validation of definitions and measures of AF burden, determination of the threshold of AF burden that results in an increased risk of stroke that warrants anticoagulation, and discovery of the mechanisms underlying the weak temporal correlations of AF and stroke. Moreover, developments in monitoring technologies will likely change the landscape of long-term AF monitoring and could allow better definition of the significance of changes in AF burden over time.
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                Author and article information

                Journal
                Title: JAMA
                Abbreviated Title: JAMA
                Publisher: American Medical Association (AMA)
                ISSN (Print): 0098-7484
                Publication date Created: July 10 2018
                Publication date (Print): July 10 2018
                Volume: 320
                Issue: 2
                Page: 146
                Affiliations
                [1 ]Scripps Translational Science Institute, La Jolla, California
                [2 ]Wave Research Center, La Jolla, California
                [3 ]Healthagen Outcomes, Chicago, Illinois
                [4 ]Janssen Scientific Affairs, Titusville, New Jersey
                Article
                DOI: 10.1001/jama.2018.8102
                PMC ID: 6583518
                PubMed ID: 29998336
                SO-VID: 9a54b534-a488-4bc6-a944-5395d817132a
                Copyright © © 2018
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