Targeted use of anticoagulants in arrhythmias
Atrial fibrillation is the most common type of arrhythmia in the Western world and is responsible for about 25% of all ischemic strokes. Preventive treatment with anticoagulants can significantly reduce the risk of stroke in atrial fibrillation. However, the main problem is that in many patients atrial fibrillation is not detected in time. Due to continuous technical progress, innovative strategies, especially in remote medical monitoring, are increasingly finding their way into the medical field. A number of studies have demonstrated increased detection of previously unknown atrial fibrillation by opportunistic screening using pulse-wave light analysis (PPG). This analysis can be done very easily using traditional smartphone cameras or smart watches. However, the effectiveness of this digital screening strategy in direct comparison to conventional screening for atrial fibrillation has not been adequately investigated to date.
The study “Bavarian Alternative Electronic Health-Based Detection of Atrial Fibrillation (eBRAVE-AF)” was a randomized study conducted by the First Medical Clinic at the LMU Hospital in collaboration with the Medical University of Innsbruck under the direction of Prof. Dr. Axel Bauer and special lecturer d. Konstantinos Rizas of the Medical Clinic and Polyclinic I at the LMU Klinikum Munich. The results were presented at the Congress of the European Society of Cardiology in Barcelona as part of the Hotline session on August 28, 2022 and simultaneously published in the important journal Nature Medicine.
67,488 Versicherungskammer Bayern policyholders, selected according to age (50 years) and other risk factors, were informed of the study by mail and invited to participate in the study. The digital strategy for atrial fibrillation screening was compared to the conventional screening for atrial fibrillation in 5551 participants. The digital examination consisted of repeated measurements of the pulse wave for one minute using an approved smartphone app (Preventicus Heartbeats) and in the case of an abnormal measurement, the results were confirmed by a long-term electrocardiogram.
Digitally detect atrial fibrillation, reduce stroke risk
We conducted the study purely digitally without physical contact with the study participants. That was a huge challenge. Our most important tool for communication and coordination was a specially developed study app on the participants’ smartphones,” says Bauer. A total of 125 participants with atrial fibrillation were newly diagnosed in the course of the study. In 100 of these participants, this diagnosis led to the initiation of anticonvulsant therapy. Anticoagulation for stroke prevention.In addition, digital smartphone screening doubled the sensitivity for detecting atrial fibrillation.
Special Lecturer Dr. Risa: “The results of this study are of great importance in the early detection of atrial fibrillation, which is an irregular heartbeat associated with an increased risk of stroke without treatment. This technology can be easily applied to any iOS or Android smartphone and can create Population-wide early detection programs for diagnosing atrial fibrillation and preventing stroke. Future studies should now clarify to what extent this digital screening strategy can improve patients’ long-term prognosis.”
Risa KD, Freer L, Sabler N. et al. Smartphone screening for atrial fibrillation: a randomized clinical trial. night with (2022).