scholarly journals A Heart Rate Monitoring App (FibriCheck) for Atrial Fibrillation in General Practice: Pilot Usability Study

10.2196/24461 ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. e24461
Author(s):  
Simon Gabriël Beerten ◽  
Tine Proesmans ◽  
Bert Vaes
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Patient Compliance ◽  
User Experience ◽  
Short Form ◽  
Heart Rhythm ◽  
Cluster Randomized Trial ◽  
Smartphone App ◽  
Pulse Palpation ◽  
A Charge

Background Atrial fibrillation (AF) is a major risk factor for stroke. The current opportunistic screening procedure consists of pulse palpation and an electrocardiogram when an irregular rhythm is found. Smartphone apps that measure heart rhythm could be useful in increasing the detection of AF in a primary care setting. Objective We conducted a pilot study with the smartphone app FibriCheck to assess whether the introduction of such an app is feasible. Methods Four general practices across Flanders provided patient data for the study. Inclusion criteria for participants were aged 65 or older and a CHARGE-AF score of at least 10%. We excluded patients with known AF or a pacemaker. Participants were asked to measure at least twice a day with FibriCheck (for at least 14 days). They were provided the 36-Item Short Form Survey (SF-36) questionnaire both before and after the study, as well as different surveys concerning their user experience and general perception of technology. Results There were 92 participants (36 women and 56 men). The study population was relatively homogenous concerning risk factors and medication use at baseline. During the study period, 5/86 (6%) participants were found to have AF (6 dropouts). The average study period was 23 days and the average number of measurements per day was 2.1. Patient compliance was variable, but high. On the whole, there were no appreciable changes in quality of life. The overall user experience and satisfaction were very high. Conclusions FibriCheck is a relatively easy-to-use smartphone app to complement AF screening in primary care. Its implementation in this setting is certainly achievable, and one can expect high rates of patient compliance. Based on these results, a planned cluster randomized trial will be going ahead. Trial Registration ClinicalTrials.gov NCT03509493; https://clinicaltrials.gov/ct2/show/NCT03509493

scholarly journals A Heart Rate Monitoring App (FibriCheck) for Atrial Fibrillation in General Practice: Pilot Usability Study (Preprint)

2020 ◽  
Author(s):  
Simon Gabriël Beerten ◽  
Tine Proesmans ◽  
Bert Vaes
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Patient Compliance ◽  
User Experience ◽  
Short Form ◽  
Heart Rhythm ◽  
Cluster Randomized Trial ◽  
Smartphone App ◽  
Pulse Palpation ◽  
A Charge

BACKGROUND Atrial fibrillation (AF) is a major risk factor for stroke. The current opportunistic screening procedure consists of pulse palpation and an electrocardiogram when an irregular rhythm is found. Smartphone apps that measure heart rhythm could be useful in increasing the detection of AF in a primary care setting. OBJECTIVE We conducted a pilot study with the smartphone app FibriCheck to assess whether the introduction of such an app is feasible. METHODS Four general practices across Flanders provided patient data for the study. Inclusion criteria for participants were aged 65 or older and a CHARGE-AF score of at least 10%. We excluded patients with known AF or a pacemaker. Participants were asked to measure at least twice a day with FibriCheck (for at least 14 days). They were provided the 36-Item Short Form Survey (SF-36) questionnaire both before and after the study, as well as different surveys concerning their user experience and general perception of technology. RESULTS There were 92 participants (36 women and 56 men). The study population was relatively homogenous concerning risk factors and medication use at baseline. During the study period, 5/86 (6%) participants were found to have AF (6 dropouts). The average study period was 23 days and the average number of measurements per day was 2.1. Patient compliance was variable, but high. On the whole, there were no appreciable changes in quality of life. The overall user experience and satisfaction were very high. CONCLUSIONS FibriCheck is a relatively easy-to-use smartphone app to complement AF screening in primary care. Its implementation in this setting is certainly achievable, and one can expect high rates of patient compliance. Based on these results, a planned cluster randomized trial will be going ahead. CLINICALTRIAL ClinicalTrials.gov NCT03509493; https://clinicaltrials.gov/ct2/show/NCT03509493

scholarly journals Electrocardiographic screening in primary care for cardiovascular disease risk and atrial fibrillation

2019 ◽  
Vol 20 ◽  
Author(s):  
Ralf E. Harskamp
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Diagnostic Testing ◽  
Routine Care ◽  
Pulse Palpation ◽  
Primary Care Patients ◽  
Ecg Abnormalities

Abstract Electrocardiograms (ECGs) are frequently recorded in primary care for screening purposes. An ECG is essential in diagnosing atrial fibrillation, and ECG abnormalities are associated with cardiovascular events. While recent studies show that ECGs adequately reclassify a proportion of patients based on the clinical risk score calculations, there are no data to support that this also results in improved health outcomes. When applied for screening for atrial fibrillation, more cases are found with routine care, but this would be undone when physicians would perform systematic pulse palpation. In most studies, the harms of routine ECG use (such as unnecessary diagnostic testing, emotional distress, increased health expenses) were poorly documented. As such, the routine performing of ECGs in asymptomatic primary care patients, whether it is for cardiovascular disease risk assessment or atrial fibrillation, cannot be recommended.

scholarly journals The effect of a case-finding app on the detection rate of atrial fibrillation compared with opportunistic screening in primary care patients: protocol for a cluster randomized trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Simon Gabriël Beerten ◽  
Tine Proesmans ◽  
Bert Vaes
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Randomized Trial ◽  
Paroxysmal Atrial Fibrillation ◽  
Detection Rate ◽  
Care Setting ◽  
Primary Care Setting ◽  
Cluster Randomized Trial ◽  
Opportunistic Screening ◽  
Cluster Randomized

Abstract Background Atrial fibrillation is a cardiac arrhythmia commonly encountered in a primary care setting. Current screening is limited to pulse palpation and ECG confirmation when an irregular pulse is found. Paroxysmal atrial fibrillation will, however, still be difficult to pick up. With the advent of smartphones, screening could be more cost-efficient by making use of simple applications, lowering the need for intensive screening to discover (paroxysmal) atrial fibrillation. Methods/design This cluster randomized trial will examine the effect of using a smartphone-based application such as FibriCheck® on the detection rate of atrial fibrillation in a Flemish general practice population. This study will be conducted in 22 primary care practices across the Flanders region of Belgium and will last 12 months. Patients above 65 years of age will be divided in control and intervention groups on the practice level. The control group will be subjected to standard opportunistic screening only, while the intervention group will be prescribed the FibriCheck® app on top of this opportunistic screening. The difference in detection rate between control and intervention groups will be calculated at the end of the study. We will use the online platform INTEGO for pseudonymized data collection and analysis, and risk calculation. Discussion Smartphone applications might offer a way to cost-effectively screen for (paroxysmal) atrial fibrillation in a primary care setting. This could open the door for the update of future screening guidelines. Trial registration ClinicalTrials.gov NCT04545723. Registered on September 10, 2020.

scholarly journals Improving stroke prevention therapy for patients with atrial fibrillation in primary care: protocol for a pragmatic, cluster-randomized trial

2016 ◽  
Vol 11 (1) ◽  
Author(s):  
Theresa M. Lee ◽  
Noah M. Ivers ◽  
Sacha Bhatia ◽  
Debra A. Butt ◽  
Paul Dorian ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Randomized Trial ◽  
Stroke Prevention ◽  
Cluster Randomized Trial ◽  
Care Protocol ◽  
Prevention Therapy ◽  
Cluster Randomized

scholarly journals Universal prevention of depression in women postnatally: cluster randomized trial evidence in primary care

2010 ◽  
Vol 41 (4) ◽  
pp. 739-748 ◽  
Author(s):  
T. S. Brugha ◽  
C. J. Morrell ◽  
P. Slade ◽  
S. J. Walters
Keyword(s):  
Primary Care ◽  
Postnatal Depression ◽  
Outcome Measure ◽  
Psychological Intervention ◽  
Short Form ◽  
Intervention Group ◽  
Depression Scale ◽  
Cluster Randomized Trial ◽  
Stress Index ◽  
Control Group

BackgroundTo test whether receiving care from a health visitor (HV) trained in identification and psychological intervention methods prevents depression 6–18 months postnatally in women who are not depressed 6 weeks postnatally.MethodThe study was a prospective cluster trial, randomized by GP practice, with follow-up for 18 months in 101 primary care teams in the Trent area of England. The participants were women scoring <12 on the postal Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks postnatally (1474 intervention and 767 control women). Intervention HVs (n=89, 63 clusters) were trained in identifying depressive symptoms using the EPDS and face-to-face clinical assessment and in providing psychologically orientated sessions based on cognitive behavioral or person-centered principles. The control group comprised HVs (n=49, 37 clusters) providing care as usual (CAU). The primary outcome measure was the proportion of women scoring ⩾12 on the EPDS at 6 months postnatally. Secondary outcomes were mean EPDS score, Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) score, State–Trait Anxiety Inventory (STAI), 12-item Short Form Health Survey (SF-12) and Parenting Stress Index Short Form (PSI-SF) scores at 6, 12 and 18 months.ResultsAfter adjusting for individual-level covariates, living alone, previous postnatal depression (PND), the presence of one or more adverse life events and the 6-week EPDS score, the odds ratio (OR) for EPDS ⩾12 at 6 months was 0.71 [95% confidence interval (CI) 0.53–0.97, p=0.031] for the intervention group (IG) women compared with the control (CAU) group women. Two subgroups were formed by baseline severity: a ‘subthreshold’ subgroup with a 6-week EPDS score of 6–11 (n=999) and a ‘lowest severity’ subgroup with a 6-week EPDS score of 0–5 (n=1242). There was no difference in psychological effectiveness by subgroup (interaction term: z=−0.28, p=0.782).ConclusionsThis study provides new evidence of a universal, enduring preventive effect for depression in women who screen negative for depression postnatally.

scholarly journals Continuous electrocardiography for detecting atrial fibrillation beyond 1 year after stroke in primary care

Heart ◽  
2020 ◽  
pp. heartjnl-2020-316904
Author(s):  
Louise Feldborg Lyckhage ◽  
Morten Lock Hansen ◽  
Jens Christian Toft ◽  
Susanne Lis Larsen ◽  
Bente Brendorp ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Diagnostic Yield ◽  
Univariate Analysis ◽  
Holter Monitoring ◽  
Number Needed To Screen ◽  
Pulse Palpation ◽  
Diagnostic Benefit

Background and purposeThe diagnostic benefit of using continuous ECG (cECG) for poststroke atrial fibrillation (AF) screening in a primary care setting is unclear. We aimed to assess the diagnostic yield from screening patients who previously had a stroke with a 7-day Holter monitor.MethodsPatients older than 49 years, naive to AF, with an ischaemic stroke over 1 year before enrolment were included. In a primary care setting, all patients were screened for AF using pulse palpation, 12-lead ECG and 7-day Holter monitoring. Further, NT-proBNP was determined at baseline.Results7-day Holter monitoring uncovered AF in 17 of 366 patients (4.6% (95% CI 2.7 to 7.3)). The number needed to screen was 22 patients (14–37). 12-lead ECG uncovered AF in 3 patients (0.82% (95% CI 0.17 to 2.4)), and 122 patients had irregular pulse during pulse palpation (33.5% (95% CI 28.7 to 38.2)). When using 7-day Holter monitoring as reference standard, the sensitivity of pulse palpation and 12-lead ECG was 47% (95% CI 23% to 72%) and 18% (95% CI 4% to 43%). High levels (≥400 pg/mL) of NT-proBNP versus low levels (≤200 pg/mL) were not associated with AF in the univariate analysis nor when adjusted for age (OR 2.4 (95% CI 0.5 to 8.4) and 1.6 (95% CI 0.3 to 6.0)).ConclusionsA relevant proportion of patients with stroke more than 1 year before inclusion were diagnosed with AF through 7-day Holter monitoring. Given the low sensitivities of pulse palpation and 12-lead ECG, additional cECG may be considered during poststroke primary care follow-up.

scholarly journals Integrated management of atrial fibrillation in primary care: results of the ALL-IN cluster randomized trial

2020 ◽  
Vol 41 (30) ◽  
pp. 2836-2844 ◽  
Author(s):  
Carline J van den Dries ◽  
Sander van Doorn ◽  
Frans H Rutten ◽  
Ruud Oudega ◽  
Sjef J C M van de Leur ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Usual Care ◽  
Randomized Trial ◽  
Integrated Care ◽  
Cluster Randomized Trial ◽  
Easy Access ◽  
Care Intervention ◽  
All Cause Mortality ◽  
Cluster Randomized

Abstract Aims To evaluate whether integrated care for atrial fibrillation (AF) can be safely orchestrated in primary care. Methods and results The ALL-IN trial was a cluster randomized, open-label, pragmatic non-inferiority trial performed in primary care practices in the Netherlands. We randomized 26 practices: 15 to the integrated care intervention and 11 to usual care. The integrated care intervention consisted of (i) quarterly AF check-ups by trained nurses in primary care, also focusing on possibly interfering comorbidities, (ii) monitoring of anticoagulation therapy in primary care, and finally (iii) easy-access availability of consultations from cardiologists and anticoagulation clinics. The primary endpoint was all-cause mortality during 2 years of follow-up. In the intervention arm, 527 out of 941 eligible AF patients aged ≥65 years provided informed consent to undergo the intervention. These 527 patients were compared with 713 AF patients in the control arm receiving usual care. Median age was 77 (interquartile range 72–83) years. The all-cause mortality rate was 3.5 per 100 patient-years in the intervention arm vs. 6.7 per 100 patient-years in the control arm [adjusted hazard ratio (HR) 0.55; 95% confidence interval (CI) 0.37–0.82]. For non-cardiovascular mortality, the adjusted HR was 0.47 (95% CI 0.27–0.82). For other adverse events, no statistically significant differences were observed. Conclusion In this cluster randomized trial, integrated care for elderly AF patients in primary care showed a 45% reduction in all-cause mortality when compared with usual care.

scholarly journals Atrial fibrillation: a geriatric perspective on the 2020 ESC guidelines

2021 ◽  
Author(s):  
M. Cristina Polidori ◽  
Mariana Alves ◽  
Gulistan Bahat ◽  
Anne Sophie Boureau ◽  
Serdar Ozkok ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Decision Making ◽  
Task Force ◽  
Real Life ◽  
Heart Rhythm ◽  
Cost Effective ◽  
Bleeding Risk ◽  
Clinical Decision ◽  
Diagnosis And Management ◽  
Pulse Palpation

Abstract Background The Task Force for the diagnosis and management of atrial fibrillation (AF) of the European Society of Cardiology (ESC) published in 2020 the updated Guidelines for the Diagnosis and Management of Atrial Fibrillation with the contribution of the European Heart Rhythm Association (EHRA) of the ESC and the European Association for Cardiothoracic Surgery (EACTS). Methods and results In this narrative viewpoint, we approach AF from the perspective of aging medicine and try to provide the readers with information usually neglected in clinical routine, mainly due to the fact that while the large majority of AF patients in real life are older, frail and cognitively impaired, these are mostly excluded from clinical trials, and physicians’ attitudes often prevail over standardized algorithms. Conclusions On the basis of existing evidence, (1) opportunistic AF screening by pulse palpation or ECG rhythm strip is cost-effective, and (2) whereas advanced chronological age by itself is not a contraindication to AF treatment, a Comprehensive Geriatric Assessment (CGA) including frailty, cognitive impairment, falls and bleeding risk may assist in clinical decision making to provide the best individualized treatment.

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