Smartphone applications for the detection of atrial fibrillation in primary care: a review (Preprint)

2020 ◽  
Author(s):  
Nicholas Fraser
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Screening Test ◽  
Low Cost ◽  
Cochrane Library ◽  
Test Accuracy ◽  
Smartphone Apps ◽  
Cross Sectional ◽  
Community Screening ◽  
Detection Algorithms

BACKGROUND Smartphone technology continues to advance at a fervid pace. In the field of cardiology, traditional physical tests recommended to detect cardiac arrhythmias may soon be superseded by low-cost, convenient and reliable smartphone apps. We aimed to determine the screening test accuracy of smartphone apps in detecting atrial fibrillation (AF) in patients within primary care. OBJECTIVE The aim of this review was to determine the screening test accuracy of smartphone apps in detecting atrial fibrillation (AF) in patients within primary care. METHODS Systematically searched MEDLINE, PUBMED, Web of Science, CINAHL and Cochrane Library until 01 February 2019. Articles were screened, and evaluated before relevant data extracted and study quality appraised using the QUADAS-2 tool. The raw test accuracy data was constructed into a 2x2 contingency table and the test accuracy statistics were calculated, and organised in descriptive plots. RESULTS Seven cross-sectional studies tested one, or two smartphone apps including the AliveCor 1-lead 30 sec ECG (seven studies; n=16,359), and the Cardiio Rhythm PPG (one study; n=1,012). The prevalence of AF ranged from 1.17%-12.29%, with a mean of 2.65%. The AliveCor 1-lead device reported a sensitivity ranging from 0.92 to 0.99, and specificity from 0.99 to 1.00. Sensitivity and PPV showed the greatest heterogeneity, with results ranging from suboptimal to excellent. The Cardiio Rhythm PPG app recorded a sensitivity of 0.71 (95% CI 0.51-0.87) and specificity of 0.99 (95% CI 0.98-1.00). CONCLUSIONS Community screening for AF using smartphone electrocardiography (ECG) or photoplethysmography (PPG) is feasible. Smartphone apps that screen for AF in primary care demonstrate excellent specificity, but suboptimal sensitivity. Further optimisation of detection algorithms, to accommodate the spectrum of disease seen within the community, should be considered before such devices are used as a tool for systematic auto-screening.

scholarly journals CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001459
Author(s):  
Jelle C L Himmelreich ◽  
Wim A M Lucassen ◽  
Ralf E Harskamp ◽  
Claire Aussems ◽  
Henk C P M van Weert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
High Risk ◽  
The Netherlands ◽  
Patient Selection ◽  
Low Cost ◽  
Calibration Plot ◽  
Primary Care Data ◽  
C Statistic ◽  
Kaplan Meier

AimsTo validate a multivariable risk prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF)) for 5-year risk of atrial fibrillation (AF) in routinely collected primary care data and to assess CHARGE-AF’s potential for automated, low-cost selection of patients at high risk for AF based on routine primary care data.MethodsWe included patients aged ≥40 years, free of AF and with complete CHARGE-AF variables at baseline, 1 January 2014, in a representative, nationwide routine primary care database in the Netherlands (Nivel-PCD). We validated CHARGE-AF for 5-year observed AF incidence using the C-statistic for discrimination, and calibration plot and stratified Kaplan-Meier plot for calibration. We compared CHARGE-AF with other predictors and assessed implications of using different CHARGE-AF cut-offs to select high-risk patients.ResultsAmong 111 475 patients free of AF and with complete CHARGE-AF variables at baseline (17.2% of all patients aged ≥40 years and free of AF), mean age was 65.5 years, and 53% were female. Complete CHARGE-AF cases were older and had higher AF incidence and cardiovascular comorbidity rate than incomplete cases. There were 5264 (4.7%) new AF cases during 5-year follow-up among complete cases. CHARGE-AF’s C-statistic for new AF was 0.74 (95% CI 0.73 to 0.74). The calibration plot showed slight risk underestimation in low-risk deciles and overestimation of absolute AF risk in those with highest predicted risk. The Kaplan-Meier plot with categories <2.5%, 2.5%–5% and >5% predicted 5-year risk was highly accurate. CHARGE-AF outperformed CHA2DS2-VASc (Cardiac failure or dysfunction, Hypertension, Age >=75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [Female]) and age alone as predictors for AF. Dichotomisation at cut-offs of 2.5%, 5% and 10% baseline CHARGE-AF risk all showed merits for patient selection in AF screening efforts.ConclusionIn patients with complete baseline CHARGE-AF data through routine Dutch primary care, CHARGE-AF accurately assessed AF risk among older primary care patients, outperformed both CHA2DS2-VASc and age alone as predictors for AF and showed potential for automated, low-cost patient selection in AF screening.

scholarly journals The study on knowledge-attitude-practice of primary care physician toward anticoagulants therapy in Non-valvular atrial fibrillation patients in Shanghai of China

2020 ◽  
Author(s):  
Shasha Ye ◽  
Tianhao Wang ◽  
Arthur Liu ◽  
Ying Yu ◽  
Zhigang Pan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Work Experience ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Bachelor's Degree ◽  
Cluster Sampling ◽  
Primary Role ◽  
Cross Sectional ◽  
Positive Attitudes

Abstract Background As the large number of CHS centers in China face the majority of NVAF patients, primary care physicians (PCPs) play the primary role in the prevention of embolization. Therefore, an awareness of anticoagulant management in NVAF patients must be brought into focus among PCPs in China. This study will help primary care physicians (PCPs) increase their awareness of oral anticoagulant (OAC) therapy for non-valvular atrial fibrillation (NVAF) to prevent embolization.Method This was a cross-sectional observational study of 462 PCPs in community health service (CHS) centers across Shanghai. We used a self-administered questionnaire to collect data from September to December 2017. A stratified random cluster sampling was adopted in the 90 CHS centers with the family medicine residency program.Result Among 462 participants, 69.3% (320/462) of females with a medical bachelor’s degree and more than 10 years of work experience predominated in the 30 to 49 years of age group. The mean score for “knowledge,” “attitude” and “practices” of OAC therapy in NVAF patients among PCPs was 3.68±2.752, 53.62±7.148, and 37.63±10.336, respectively. The level of knowledge of OAC therapy in NVAF patients among PCPs was insufficient in over half (75.8%) of participants. The majority (89.8%) of PCPs had a positive attitude and 68.0% had modest performance in the anticoagulant management of NVAF patients.Conclusion The knowledge and behaviors of PCPs were insufficient in OAC therapy to prevent embolization in NVAF patients. The study also revealed the positive attitudes of participants, and their desire to learn the latest knowledge of OAC therapy.

scholarly journals Acceptability and Results of Dementia Screening Among Older Adults in the United States

2017 ◽  
Vol 15 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Amanda Harrawood ◽  
Nicole R. Fowler ◽  
Anthony J. Perkins ◽  
Michael A. LaMantia ◽  
Malaz A. Boustani
Keyword(s):  
United States ◽  
Older Adults ◽  
Primary Care ◽  
The United States ◽  
Cognitive Screening ◽  
Cross Sectional ◽  
Community Screening ◽  
Positive Screen ◽  
Dementia Screening ◽  
Primary Care Patients

Objectives: To measure older adults acceptability of dementia screening and assess screening test results of a racially diverse sample of older primary care patients in the United States. Design: Cross-sectional study of primary care patients aged 65 and older. Setting: Urban and suburban primary care clinics in Indianapolis, Indiana, in 2008 to 2009. Participants: Nine hundred fifty-four primary care patients without a documented diagnosis of dementia. Measurements: Community Screening Instrument for Dementia, the Mini-Mental State Examination, and the Telephone Instrument for Cognitive Screening. Results: Of the 954 study participants who consented to participate, 748 agreed to be screened for dementia and 206 refused screening. The overall response rate was 78.4%. The positive screen rate of the sample who agreed to screening was 10.2%. After adjusting for demographic differences the following characteristics were still associated with increased likelihood of screening positive for dementia: age, male sex, and lower education. Patients who believed that they had more memory problems than other people of their age were also more likely to screen positive for dementia. Conclusion: Age and perceived problems with memory are associated with screening positive for dementia in primary care.

scholarly journals Accuracy and cost-effectiveness of different screening strategies for identifying undiagnosed COPD among primary care patients (≥40 years) in China: a cross-sectional screening test accuracy study: findings from the Breathe Well group

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e051811
Author(s):  
Zihan Pan ◽  
Andrew P Dickens ◽  
Chunhua Chi ◽  
Xia Kong ◽  
Alexandra Enocson ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Screening Test ◽  
Peak Flow ◽  
Screening Tests ◽  
Test Accuracy ◽  
Reference Test ◽  
Community Health Centres ◽  
Health Centres ◽  
Accuracy Study

ObjectivesTo examine the accuracy and cost-effectiveness of various chronic obstructive pulmonary disease (COPD) screening tests and combinations within a Chinese primary care population.DesignScreening test accuracy study.SettingUrban and rural community health centres in four municipalities of China: Beijing (north), Chengdu (southwest), Guangzhou (south) and Shenyang (northeast).ParticipantsCommunity residents aged 40 years and above who attended community health centres for any reason were invited to participate. 2445 participants (mean age 59.8 (SD 9.6) years, 39.1% (n=956) male) completed the study (February–December 2019), 68.9% (n=1684) were never-smokers and 3.6% (n=88) had an existing COPD diagnosis. 13.7% (n=333) of participants had spirometry-confirmed airflow obstruction.InterventionsParticipants completed six index tests (screening questionnaires (COPD Diagnostic Questionnaire, COPD Assessment in Primary Care To Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE), Chinese Symptom-Based Questionnaire (C-SBQ), COPD-SQ), microspirometry (COPD-6), peak flow (model of peak flow meters used in the study (USPE)) and the reference test (ndd Easy On-PC).Primary and secondary outcomesCases were defined as those with forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) below the lower limit of normal (LLN-GLI) on the reference test. Performance of individual screening tests and their combinations was evaluated, with cost-effectiveness analyses providing cost per additional true case detected.ResultsAirflow measurement devices (sensitivities 64.9% (95% CI 59.5% to 70.0%) and 67.3% (95% CI 61.9% to 72.3%), specificities 89.7% (95% CI 88.4% to 91.0%) and 82.6% (95% CI 80.9% to 84.2%) for microspirometry and peak flow, respectively) generally performed better than questionnaires, the most accurate of which was C-SBQ (sensitivity 63.1% (95% CI 57.6% to 68.3%) specificity 74.2% (95% CI 72.3% to 76.1%)). The combination of C-SBQ and microspirometry used in parallel maximised sensitivity (81.4%) (95% CI 76.8% to 85.4%) and had specificity of 68.0% (95% CI 66.0% to 70.0%), with an incremental cost-effectiveness ratio of £64.20 (CNY385) per additional case detected compared with peak flow.ConclusionsSimple screening tests to identify undiagnosed COPD within the primary care setting in China is possible, and a combination of C-SBQ and microspirometry is the most sensitive and cost-effective. Further work is required to explore optimal cut-points and effectiveness of programme implementation.Trial registration numberISRCTN13357135.

scholarly journals Digital Recruitment and Acceptance of a Stepwise Model to Prevent Chronic Disease in the Danish Primary Care Sector: Cross-Sectional Study (Preprint)

2018 ◽  
Author(s):  
Lars Bruun Larsen ◽  
Jens Sondergaard ◽  
Janus Laust Thomsen ◽  
Anders Halling ◽  
Anders Larrabee Sønderlund ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Low Cost ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Chi Square ◽  
Cross Sectional ◽  
Interaction Detection ◽  
Health Checks

BACKGROUND During recent years, stepwise approaches to health checks have been advanced as an alternative to general health checks. In 2013, we set up the Early Detection and Prevention project (Tidlig Opsporing og Forebyggelse, TOF) to develop a stepwise approach aimed at patients at high or moderate risk of a chronic disease. A novel feature was the use of a personal digital mailbox for recruiting participants. A personal digital mailbox is a secure digital mailbox provided by the Danish public authorities. Apart from being both safe and secure, it is a low-cost, quick, and easy way to reach Danish residents. OBJECTIVE In this study we analyze the association between the rates of acceptance of 2 digital invitations sent to a personal digital mailbox and the sociodemographic determinants, medical treatment, and health care usage in a stepwise primary care model for the prevention of chronic diseases. METHODS We conducted a cross-sectional analysis of the rates of acceptance of 2 digital invitations sent to randomly selected residents born between 1957 and 1986 and residing in 2 Danish municipalities. The outcome was acceptance of the 2 digital invitations. Statistical associations were determined by Poisson regression. Data-driven chi-square automatic interaction detection method was used to generate a decision tree analysis, predicting acceptance of the digital invitations. RESULTS A total of 8814 patients received an invitation in their digital mailbox from 47 general practitioners. A total of 40.22% (3545/8814) accepted the first digital invitation, and 30.19 % (2661/8814) accepted both digital invitations. The rates of acceptance of both digital invitations were higher among women, older patients, patients of higher socioeconomic status, and patients not diagnosed with or being treated for diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular disease. CONCLUSIONS To our knowledge, this is the first study to report on the rates of acceptance of digital invitations to participate in a stepwise model for prevention of chronic diseases. More studies of digital invitations are needed to determine if the acceptance rates seen in this study should be expected from future studies as well. Similarly, more research is needed to determine whether a multimodal recruitment approach, including digital invitations to personal digital mailboxes will reach hard-to-reach subpopulations more effectively than digital invitations only.

scholarly journals Tracking the progress of primary care reforms in Kerala India: Findings from a baseline assessment

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Negi ◽  
D Nambiar
Keyword(s):  
Primary Care ◽  
Low Cost ◽  
Family Health ◽  
Health Staff ◽  
Base Line ◽  
Baseline Assessment ◽  
Cross Sectional ◽  
Outcome Indicators ◽  
South Indian ◽  
Health Centres

Abstract The south Indian state of Kerala has a legacy of gains in population health at a low cost. Kerala's recent health reform initiative has emphasized increasing the scope and quality of primary care services. Beginning in 2017, 171 of 848 Primary Health Centres (PHCs) were upgraded to Family Health Centres (FHCs) by increasing staff, training, infrastructure and working hours. In support of this process, we carried out a baseline assessment to assess differences between upgraded FHCs and PHCs We undertook a cross-sectional study in four districts randomly selected from clusters made using data from the latest National Family Health Survey (2015-16). One FHC and PHC per district were randomly chosen. Monitoring indicators were selected through a modified Delphi process; a structured questionnaire was shared with health staff to report data for the financial year 2018-19. The eight facilities jointly served a population of 2,79,992 (60% in FHC). The proportion of average monthly outpatients to the population served was 8.3% in FHCs as against 7.9% in PHCs. The patients screened for high blood pressure and blood sugar in FHCs was nearly double that in PHCs. FHCs were better equipped with patient amenities, laboratory and staff. Coverage indicators like full antenatal care, full immunisation were higher than the national average but not appreciably different in PHCs versus FHCs, nor were health outcomes like low birth weight among infants and acute diarrhoeal diseases among under-fives. Findings were presented to the facility, district and state officials and feedback sought. Primary care reforms in Kerala has improved infrastructure but are still in their early days, reflected in the lack of difference in coverage and outcome indicators. A robust monitoring process benefits from periodic surveys providing valuable insights to the program implementation Key messages Health care reforms in resource poor settings need to be monitored rigorously and constructing a base line data is vital in measuring the change. Primary care reforms in Kerala has improved infrastructure but are still in their early days, reflected in the lack of difference in coverage and outcome indicators.

scholarly journals Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review

10.2196/17572 ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. e17572 ◽  
Author(s):  
Dorothy Szinay ◽  
Andy Jones ◽  
Tim Chadborn ◽  
Jamie Brown ◽  
Felix Naughton
Keyword(s):  
Systematic Review ◽  
Low Cost ◽  
Theoretical Domains Framework ◽  
Well Being ◽  
Database Systems ◽  
Health Impact ◽  
Cochrane Library ◽  
Smartphone Apps ◽  
Wide Range ◽  
Health And Well Being

Background The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. Objective This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. Methods We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Results Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Conclusions Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps.

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