Automatic Mobile Health Arrhythmia Monitoring for the Detection of Atrial Fibrillation: Prospective Feasibility, Accuracy, and User Experience Study

Background Atrial fibrillation (AF) is the most common tachyarrhythmia and associated with a risk of stroke. The detection and diagnosis of AF represent a major clinical challenge due to AF’s asymptomatic and intermittent nature. Novel consumer-grade mobile health (mHealth) products with automatic arrhythmia detection could be an option for long-term electrocardiogram (ECG)-based rhythm monitoring and AF detection. Objective We evaluated the feasibility and accuracy of a wearable automated mHealth arrhythmia monitoring system, including a consumer-grade, single-lead heart rate belt ECG device (heart belt), a mobile phone application, and a cloud service with an artificial intelligence (AI) arrhythmia detection algorithm for AF detection. The specific aim of this proof-of-concept study was to test the feasibility of the entire sequence of operations from ECG recording to AI arrhythmia analysis and ultimately to final AF detection. Methods Patients (n=159) with an AF (n=73) or sinus rhythm (n=86) were recruited from the emergency department. A single-lead heart belt ECG was recorded for 24 hours. Simultaneously registered 3-lead ECGs (Holter) served as the gold standard for the final rhythm diagnostics and as a reference device in a user experience survey with patients over 65 years of age (high-risk group). Results The heart belt provided a high-quality ECG recording for visual interpretation resulting in 100% accuracy, sensitivity, and specificity of AF detection. The accuracy of AF detection with the automatic AI arrhythmia detection from the heart belt ECG recording was also high (97.5%), and the sensitivity and specificity were 100% and 95.4%, respectively. The correlation between the automatic estimated AF burden and the true AF burden from Holter recording was >0.99 with a mean burden error of 0.05 (SD 0.26) hours. The heart belt demonstrated good user experience and did not significantly interfere with the patient’s daily activities. The patients preferred the heart belt over Holter ECG for rhythm monitoring (85/110, 77% heart belt vs 77/109, 71% Holter, P=.049). Conclusions A consumer-grade, single-lead ECG heart belt provided good-quality ECG for rhythm diagnosis. The mHealth arrhythmia monitoring system, consisting of heart-belt ECG, a mobile phone application, and an automated AF detection achieved AF detection with high accuracy, sensitivity, and specificity. In addition, the mHealth arrhythmia monitoring system showed good user experience. Trial Registration ClinicalTrials.gov NCT03507335; https://clinicaltrials.gov/ct2/show/NCT03507335

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On-Demand Mobile Health Infrastructure for Remote Rhythm Monitoring within a Wait-and-See Strategy for Recent-Onset Atrial Fibrillation: TeleWAS-AF

Cardiology ◽

10.1159/000514156 ◽

2021 ◽

pp. 1-5

Author(s):

Nikki A.H.A. Pluymaekers ◽

Rachel M.J. van der Velden ◽

Astrid N.L. Hermans ◽

Monika Gawalko ◽

Saskia Buskes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Mobile Health ◽

Treatment Decision ◽

Care Process ◽

Care Utilization ◽

Recent Onset ◽

On Demand ◽

Wait And See ◽

Rhythm Monitoring

Recently, we introduced the TeleCheck-AF approach, an on-demand mobile health (mHealth) infrastructure using app-based heart rate and rhythm monitoring for 7 days, to support long-term atrial fibrillation (AF) management through teleconsultation. Herein, we extend the mHealth approach to patients with recent-onset AF at the emergency department (ED). In the proposed TeleWAS-AF approach, on-demand heart rate and rhythm monitoring are used to support a wait-and-see strategy at the ED. All stable patients who present to the ED with recent-onset symptomatic AF and who are able to use mHealth solutions for heart rate and rhythm monitoring are eligible for this approach. Patients will receive both education on AF and instructions on the use of the mHealth technology before discharge from the ED. A case coordinator will subsequently check whether patients are able to activate the mHealth solution and to perform heart rate and rhythm measurements. Forty hours after AF onset, the first assessment teleconsultation with the physician will take place, determining the need for delayed cardioversion. After maximal 7 days of remote monitoring, a second assessment teleconsultation may occur, in which the rhythm can be reassessed and further treatment strategy can be discussed with the patients. This on-demand mHealth prescription increases patient involvement in the care process and treatment decision-making by encouraging self-management, while avoiding excess data-load requiring work-intensive and expensive data management. Implementation of the TeleWAS-AF approach may facilitate the management of AF in the ED and reduce the burden on the ED system, which enhances the capacity for health care utilization.

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Detection of Paroxysmal Atrial Fibrillation in Stroke/Tia Patients

Stroke Research and Treatment ◽

10.1155/2013/840265 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Muhib Khan ◽

Daniel J. Miller

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Cardiac Rhythm ◽

Genetic Factors ◽

Arrhythmia Detection ◽

Ischemic Attack ◽

Event Definition ◽

Possible Cause ◽

Rhythm Monitoring

One-third of stroke and transient ischemic attack (TIA) are cryptogenic, and paroxysmal atrial fibrillation (PAF) has been suggested as a possible cause for these cryptogenic strokes. Multiple studies have recently evaluated long-term cardiac rhythm monitoring with good yield for PAF. The duration of monitoring varies between studies as well as the qualifying event definition. Moreover, the clinical significance of very brief atrial fibrillation events is unclear in the literature. This paper provides an overview of current advances in the detection of paroxysmal atrial fibrillation, the clinical and genetic factors predictive of arrhythmia detection, and the therapeutic dilemma concerning this approach.

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PCV134 MOBILE HEALTH TECHNOLOGY PERCEPTIONS AND USER EXPERIENCE AMONG ATRIAL FIBRILLATION PATIENTS: A SOCIAL MEDIA LISTENING STUDY

Value in Health ◽

10.1016/j.jval.2019.09.858 ◽

2019 ◽

Vol 22 ◽

pp. S566

Author(s):

S. Halhol ◽

S. Pan ◽

A. Cox ◽

E. Merinopoulou ◽

M. Oguz ◽

...

Keyword(s):

Atrial Fibrillation ◽

Social Media ◽

User Experience ◽

Mobile Health ◽

Health Technology ◽

Mobile Health Technology ◽

Technology Perceptions

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Coordination of a remote mHealth infrastructure for atrial fibrillation management during COVID-19 and beyond: TeleCheck-AF

International Journal of Care Coordination ◽

10.1177/2053434520954619 ◽

2020 ◽

Vol 23 (2-3) ◽

pp. 65-70 ◽

Cited By ~ 3

Author(s):

Rachel MJ van der Velden ◽

Astrid NL Hermans ◽

Nikki AHA Pluymaekers ◽

Monica Gawalko ◽

Bianca Vorstermans ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Mobile Health ◽

Multidisciplinary Team ◽

Mhealth Intervention ◽

On Demand ◽

Outpatient Visits ◽

Care Processes ◽

Multiple Levels ◽

Rhythm Monitoring

During the coronavirus 2019 (COVID-19) pandemic, outpatient visits for patients with atrial fibrillation (AF), were converted into teleconsultations. As a response to this, a novel mobile health (mHealth) intervention was developed to support these teleconsultations with AF patients: TeleCheck-AF. This approach incorporates three fundamental components: 1) “Tele”: A structured teleconsultation. 2) “Check”: An app-based on-demand heart rate and rhythm monitoring infrastructure. 3) “AF”: comprehensive AF management. This report highlights the significant importance of coordination of the TeleCheck-AF approach at multiple levels and underlines the importance of streamlining care processes provided by a multidisciplinary team, using an mHealth intervention, during the COVID-19 pandemic. Moreover, this report reflects on how the TeleCheck-AF approach has contributed to strengthening the health system in maintaining management of this prevalent sustained cardiac arrhythmia, whilst keeping patients out of hospital, during the pandemic and beyond.

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Implementation of an on-demand app-based heart rate and rhythm monitoring infrastructure for the management of atrial fibrillation through teleconsultation: TeleCheck-AF

EP Europace ◽

10.1093/europace/euaa201 ◽

2020 ◽

Cited By ~ 6

Author(s):

Nikki A H A Pluymaekers ◽

Astrid N L Hermans ◽

Rachel M J van der Velden ◽

Monika Gawałko ◽

Dennis W den Uijl ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Integrated Care ◽

Mobile Health ◽

Multidisciplinary Team ◽

Care Process ◽

Mhealth Intervention ◽

On Demand ◽

Outpatient Visits ◽

Rhythm Monitoring

Abstract During the coronavirus 2019 (COVID-19) pandemic, outpatient visits in the atrial fibrillation (AF) clinic of the Maastricht University Medical Centre (MUMC+) were transferred into teleconsultations. The aim was to develop an on-demand app-based heart rate and rhythm monitoring infrastructure to allow appropriate management of AF through teleconsultation. In line with the fundamental aspects of integrated care, including actively involving patients in the care process and providing comprehensive care by a multidisciplinary team, we implemented a mobile health (mHealth) intervention to support teleconsultations with AF patients: TeleCheck-AF. The TeleCheck-AF approach guarantees the continuity of comprehensive AF management and supports integrated care through teleconsultation during COVID-19. It incorporates three important components: (i) a structured teleconsultation (‘Tele’), (ii) a CE-marked app-based on-demand heart rate and rhythm monitoring infrastructure (‘Check’), and (iii) comprehensive AF management (‘AF’). In this article, we describe the components and implementation of the TeleCheck-AF approach in an integrated and specialized AF-clinic through teleconsultation. The TeleCheck-AF approach is currently implemented in numerous European centres during COVID-19.

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2247Diagnostic accuracy of a novel mobile phone application in monitoring atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehx502.2247 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

G. Rozen ◽

J. Vaid ◽

S.M. Hosseini ◽

A. Rafael ◽

A. Roka ◽

...

Keyword(s):

Atrial Fibrillation ◽

Mobile Phone ◽

Mobile Phone Application

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A Remote Cardiac Rhythm Monitoring System for Detecting Episodes of Atrial Fibrillation

Biomedical Engineering ◽

10.1007/s10527-017-9712-9 ◽

2017 ◽

Vol 51 (3) ◽

pp. 189-194 ◽

Cited By ~ 5

Author(s):

Tr. T. Nguyen ◽

Z. M. Yuldashev ◽

E. V. Sadykova

Keyword(s):

Atrial Fibrillation ◽

Monitoring System ◽

Cardiac Rhythm ◽

Rhythm Monitoring

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Feasibility of Atrial Fibrillation Screening With Mobile Health Technologies at Pharmacies

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248419879089 ◽

2019 ◽

Vol 25 (2) ◽

pp. 142-151 ◽

Cited By ~ 1

Author(s):

Tomasz Zaprutko ◽

Joanna Zaprutko ◽

Artur Baszko ◽

Dominika Sawicka ◽

Anna Szałek ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sensitivity And Specificity ◽

Mobile Health ◽

Predictive Value ◽

High Sensitivity ◽

Exclusion Criterion ◽

Health Technologies ◽

Fast Screening ◽

Ischemic Attack ◽

Electrocardiogram Ecg

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Thus, the aim of our study was to evaluate the smartphone-based electrocardiogram (ECG) recordings aimed at AF screening at Polish pharmacies. Methods: Prospective AF screening among patients aged ≥65 years was conducted at 10 pharmacies using Kardia Mobile with a dedicated application (Kardia app). Prior AF was a study exclusion criterion. CHA2DS2-VASc score (congestive heart failure, hypertension, age, diabetes mellitus, previous stroke/transient ischemic attack, female sex, and vascular disease) has been collected from every patient. A single-lead ECG has been acquired by the placement of fingers from each hand on the pads. Kardia app diagnosis has been evaluated by the cardiologist. Results: A total of 525 ECGs were performed. Kardia app diagnosis was provided in 490 cases. In 437 (89.18%) cases, it was “normal” rhythm, in 17 (3.47%) recordings “possible AF,” in 23 (4.69%) ECGs “unreadable,” and in 13 (2.65%) “unclassified”. After the cardiologist reevaluation, the new AF was identified in 7 (1.33%) patients. Sensitivity and specificity of Kardia app in detecting AF was 100% (95% confidence interval [CI]: 71.5%-100%) and 98.7% (95% CI: 97.3%-99.5%), respectively. The positive predictive value was 64.7% (95% CI: 38.3%-85.7%) and the negative predictive value was 100% (95% CI: 99.2%-100%). CHA2DS2-VASc score was 2.14 ± 0.69 for those with new AF and 3.33 ± 1.26 in the non-AF group. Conclusion: Kardia app is capable of fast screening and detecting AF with high sensitivity and specificity. The possible diagnosis of AF deserves additional cardiological evaluation. The results obtained in patients with low CHA2DS2-VASc score and “silent” AF confirm the importance of routine AF screening. Cardiovascular screening with the use of mobile health technology is feasible at pharmacies.

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