scholarly journals Increased Visit-to-Visit Liver Enzyme Variability Is Associated with Incident Diabetes: A Community-Based 12-Year Prospective Cohort Study

2021 ◽  
Vol 45 (6) ◽  
pp. 890-898
Author(s):  
Kyuhoon Bang ◽  
Ji Eun Jun ◽  
In-Kyung Jeong ◽  
Kyu Jeung Ahn ◽  
Ho Yeon Chung ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Liver Enzyme ◽  
Epidemiologic Study ◽  
Tolerance Test ◽  
Incident Diabetes ◽  
Oral Glucose ◽  
Increased Risk ◽  
Heavy Alcohol Consumption ◽  
Study Participants

Background: Fatty liver and/or increased liver enzyme values have been reported to be associated with incident diabetes. We sought to determine whether increased visit-to-visit liver enzyme variability is associated with incident diabetes.Methods: Study participants were recruited from the Korean Genome and Epidemiologic Study (KoGES). A total of 4,151 people aged 40 to 69 years was recruited and tested every 2 years for up to 12 years. Visit-to-visit aspartate aminotransferase (AST) and alanine aminotransferase (ALT) variability was evaluated in first the 6-year period through the use of various variability measurements: standard deviation (SD), average successive variability, coefficient of variation (CV), and variation independent of mean (VIM). Oral glucose tolerance test was performed at every visit.Results: During the 6-year follow‐up appointments, 13.0% (538/4,151) of people developed incident diabetes. Visit-to-visit AST variability was associated with an increased risk of diabetes independent of conventional risk factors for diabetes (hazard ratio per 1-SD increment [95% confidence interval]: 1.06 [1.00 to 1.11], 1.12 [1.04 to 1.21], and 1.13 [1.04 to 1.22] for SD, CV, and VIM, respectively; all P<0.05); however, no such associations were observed in the visit-to-visit ALT variability. According to alcohol consumption status, both AST and ALT variability were independent predictors for incident diabetes in subjects with heavy alcohol consumption; however, neither AST nor ALT variability was associated with diabetes risk in subjects who did not drink alcohol heavily.Conclusion: Visit-to-visit liver enzyme variability is an independent predictor of incident diabetes. Such association was more evident in those who consumed significant amounts of alcohol.

scholarly journals Serum Uromodulin Is Associated With But Does Not Predict Type 2 Diabetes in Elderly KORA F4/FF4 Study Participants

2019 ◽  
Vol 104 (9) ◽  
pp. 3795-3802 ◽  
Author(s):  
Cornelia Then ◽  
Holger Then ◽  
Christa Meisinger ◽  
Margit Heier ◽  
Annette Peters ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glucose Tolerance ◽  
Tolerance Test ◽  
Population Based ◽  
Oral Glucose ◽  
Linear Regression Models ◽  
Glucose Tolerance Status ◽  
Study Participants

AbstractAimsSerum uromodulin has recently emerged as promising biomarker for kidney function and was suggested to be associated with type 2 diabetes (T2D) in patients with coronary heart disease. Here, we analyzed the association of serum uromodulin with T2D in the population-based KORA F4/FF4 study.MethodsIn 1119 participants of the KORA F4 study aged 62 to 81 years, serum uromodulin was measured, and the association of serum uromodulin with T2D was assessed using logistic and linear regression models stratified for sex. After a mean follow-up time of 6.5 years, 635 participants where re-evaluated. Glucose tolerance status was determined by oral glucose tolerance test at baseline and at the follow-up examination except in cases of known T2D.ResultsSerum uromodulin was inversely associated with T2D in the crude analysis and after adjustment for age and body mass index in men (P < 0.001) and in women (P < 0.05). After further adjustment for estimated glomerular filtration rate, serum uromodulin was significantly inversely associated with T2D in men (P < 0.001) but not in women. Serum uromodulin was not associated with prediabetes after multivariate adjustment and did not predict T2D in men or in women after the follow-up time of 6.5 ± 0.3 years.ConclusionsIn participants of the KORA F4 study, serum uromodulin is independently associated with T2D in men but is not a predictor of future development of T2D.

Glycemic Measures and Development and Resolution of Nonalcoholic Fatty Liver Disease in Nondiabetic Individuals

2020 ◽  
Vol 105 (5) ◽  
pp. 1416-1426
Author(s):  
Bin Wang ◽  
Mian Li ◽  
Zhiyun Zhao ◽  
Shuangyuan Wang ◽  
Jieli Lu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Nonalcoholic Fatty Liver ◽  
Increased Risk ◽  
Glycemic Regulation

Abstract Context Type 2 diabetes (T2D) is closely associated with nonalcoholic fatty liver disease (NAFLD); however, evidence regarding the link between blood glucose, especially below the threshold for T2D, and NAFLD is scarce. Objective The objective of this work is to examine the associations of fasting glucose, oral glucose tolerance test (OGTT) 2-hour glucose, and hemoglobin A1c (HbA1c), and changes in these measures with development and resolution of NAFLD in nondiabetic individuals. Methods This longitudinal cohort study comprised 4273 Chinese adults age 40 years or older and free of baseline T2D from 2010 to 2015. Blood sampling was performed during the OGTT test. NAFLD was ascertained by hepatic ultrasonography. Risk ratios (RRs) were calculated using modified Poisson regression models. Results During a mean 4.4 years of follow-up, NAFLD occurred in 573 (17.9%) of the 3209 participants without baseline NAFLD and resolved in 304 (28.6%) of the 1064 participants with baseline NAFLD. OGTT 2-h glucose was positively associated with NAFLD incidence (RR per 1-SD increase: 1.16, 95% CI: 1.08-1.25), whereas fasting (RR: 0.86, 95% CI: 0.78-0.94) and 2-hour glucose (RR: 0.85, 95% CI: 0.77-0.93) were inversely associated with resolution of NAFLD. Glycemic deterioration conferred increased risk of developing NAFLD and decreased likelihood of resolution of NAFLD than maintaining normal glycemic regulation (NGR). The strongest associations were observed for individuals who developed T2D. Meanwhile, baseline or incident NAFLD significantly increased the risk of deterioration in glucose metabolism. Conclusions Increased glycemic levels within the nondiabetic range, as well as progression from NGR to T2D or prediabetes, were adversely associated with development and improvement of NAFLD.

scholarly journals Association between FGF-19, FGF-21 and lipocalin-2, and diabetes progression in PCOS

2021 ◽  
Author(s):  
Feifei Cheng ◽  
Noel Yat Hey Ng ◽  
Claudia Ha Ting Tam ◽  
Yuying Zhang ◽  
Cadmon King Poo Lim ◽  
...  
Keyword(s):  
Fasting Glucose ◽  
Polycystic Ovary ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Lipocalin 2 ◽  
Baseline Serum ◽  
Protein Levels ◽  
Increased Risk ◽  
Diabetes Progression

Women with polycystic ovary syndrome (PCOS) have an increased risk of developing type 2 diabetes. FGF-19, FGF-21 and lipocalin-2 have emerged as important markers of metabolic risk. This study aims to compare the levels of FGF-19, FGF-21 and lipocalin-2 between subjects with and without PCOS, and to investigate the relationship between the proteins and diabetes progression. In this nested case-control cohort study, 128 Chinese PCOS women and 128 controls were recruited and followed up. All subjects underwent the oral glucose tolerance test for the evaluation of glycaemic status. Baseline serum protein levels were measured using ELISA. Compared with controls, PCOS subjects had higher levels of FGF-19 (P<0.001) and FGF-21 (P=0.022), but lower lipocalin-2 (P<0.001). In total, 20.8% of PCOS and 9.2% of controls developed diabetes over a mean duration of 10.4 ± 1.2 and 11.3 ± 0.5 years, respectively. Logistic regression analyses suggested FGF-19 was positively associated with diabetes progression in controls, after adjusting for age, follow-up duration, waist and fasting glucose (P=0.026, OR (95% CI): 7.4 (1.3-43.6)), and the positive relationship between FGF-21 and diabetes progression in controls was attenuated by adjusting for age and follow-up duration (P=0.183). Lipocalin-2 was positively correlated with diabetes progression in PCOS group (P=0.026, OR (95% CI)): 2.5 (1.1-5.6)), however, this became attenuated after adjusting for waist and fasting glucose (P=0.081). In conclusion, there is differential expression of FGF-19, FGF-21 and lipocalin-2 in PCOS. The serum level of FGF-19, FGF-21 are associated with diabetes progression in women without PCOS, while lipocalin-2 was related to diabetes progression in PCOS women.

Gestational diabetes mellitus: are mothers being followed-up? A retrospective study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697469
Author(s):  
Rebecca Ward ◽  
Fahmy W Hanna ◽  
Ann Shelley-Hitchen ◽  
Ellen Hodgson ◽  
Adrian Heald ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Median Time ◽  
Post Partum ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Tertiary Referral Centre ◽  
Alternative Approach ◽  
Nice Guidance ◽  
History Of

BackgroundWomen with gestational diabetes (GDM) have an elevated risk of developing type 2 diabetes (T2DM). NICE Guidance recommends women who develop GDM are screened 6 weeks post-partum and annually thereafter.AimTo evaluate conformity to guidance of screening in women with GDM by 6-week post-partum fasting plasma glucose (FPG) and annual FPG and determine time between delivery and development of T2DM.MethodRecords at a tertiary referral centre were used to identify women (n = 54) diagnosed with GDM by antenatal oral glucose tolerance test between July 1999 and January 2007. Data from laboratory records were used to collect investigations of glycaemic status during the follow-up period (median follow-up 12.4 years, range 9.5–17.1 years).ResultsOf 252 women, 102 (40.2%) did not have a FPG at 6 weeks (+/−2 weeks). Of these, median time to first test was 1.2 years (range 0.04–10.8 years), with only 43.1% followed-up within 1 year. In those who had a 6-week FPG, 17 (11.3%) women had no further tests. A total of 84 (33% of those with gestational diabetes in the index pregnancy) women were diagnosed with T2DM; median time from delivery to diagnosis was 5.2 years (range 0.35–15.95). We found the only significant factor for a follow-up test at 1-year post-partum was the use of insulin.ConclusionOur data suggest an alternative approach is needed for monitoring women with a history of GDM. This needs to be appropriate for a generally healthy group in which traditional screening mechanisms may not be adequate or sufficient.

scholarly journals The Association of Sensory Impairment With Incident Disability-Related Cessation of Employment in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 216-216
Author(s):  
Ahmed Shakarchi ◽  
Emmanuel Garcia Morales ◽  
Nicholas Reed ◽  
Bonnielin Swenor
Keyword(s):  
Older Adults ◽  
Hearing Aids ◽  
Population Based ◽  
Sensory Impairment ◽  
Loss To Follow Up ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
Study Participants ◽  
Adjusted Model

Abstract Sensory impairment (SI) is common among older adults, and it is an increasingly important public health challenge as the population ages. We evaluated the association between SI and incident disability-related cessation of employment in older adults using the population-based Health and Retirement Study. Participants employed in 2006 completed biennial interviews until self-reported incident disability-related cessation of employment. Participants were censored at loss to follow-up, retirement, or 2018. Participants rated their vision and hearing, using eyeglasses or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, excellent). SI was defined as poor or fair ability, and SI was categorized as neither SI (NSI), vision impairment alone (VI), hearing impairment alone (HI), and dual SI (DSI). Cox proportional hazard regression assessed the association between SI and incident disability-related cessation of employment, adjusting for demographic and health covariates. Overall, 4726 participants were included: 421 (8.9%) were with VI, 487 (10.3) with HI, and 203 (4.3%) with DSI. Mean age was 61.0 ± 6.8 years, 2488 (52.6%) were women, and 918 (19.4) were non-White. In the fully adjusted model, incident disability-related cessation of employment over the 12-year follow-up period was higher in VI (Hazard Ratio (HR)=1.30, 95% confidence interval (CI)=0.92, 1.85), HI (HR=1.60, CI=1.16, 2.22), and DSI (HR=2.02, CI=1.38, 2.96). These findings indicate that employed older adults with SI are at increased risk of incident disability-related cessation of employment, and that older adults with DSI are particularly vulnerable. Addressing SI in older adults may lengthen their contribution to the workforce.

scholarly journals Dietary Micronutrients and Risk of Chronic Kidney Disease: A Cohort Study with 12 Year Follow-Up

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1517
Author(s):  
Juyeon Lee ◽  
Kook-Hwan Oh ◽  
Sue-Kyung Park
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Epidemiologic Study ◽  
Population Based ◽  
Dietary Guidelines ◽  
Dietary Intakes ◽  
Increased Risk ◽  
Ckd Stage

We investigated the association between dietary micronutrient intakes and the risk of chronic kidney disease (CKD) in the Ansan-Ansung study of the Korean Genome and Epidemiologic Study (KoGES), a population-based prospective cohort study. Of 9079 cohort participants with a baseline estimate glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 and a urine albumin to creatinine ratio (UACR) <300 mg/g and who were not diagnosed with CKD, we ascertained 1392 new CKD cases over 12 year follow-up periods. The risk of CKD according to dietary micronutrient intakes was presented using hazard ratios (HRs) and 95% confidence intervals (95% CIs) in a full multivariable Cox proportional hazard models, adjusted for multiple micronutrients and important clinico-epidemiological risk factors. Low dietary intakes of phosphorus (<400 mg/day), vitamin B2 (<0.7 mg/day) and high dietary intake of vitamin B6 (≥1.6 mg/day) and C (≥100 mg/day) were associated with an increased risk of CKD stage 3B and over, compared with the intake at recommended levels (HR = 6.78 [95%CI = 2.18–21.11]; HR = 2.90 [95%CI = 1.01–8.33]; HR = 2.71 [95%CI = 1.26–5.81]; HR = 1.83 [95%CI = 1.00–3.33], respectively). In the restricted population, excluding new CKD cases defined within 2 years, an additional association with low folate levels (<100 µg/day) in higher risk of CKD stage 3B and over was observed (HR = 6.72 [95%CI = 1.40–32.16]). None of the micronutrients showed a significant association with the risk of developing CKD stage 3A. Adequate intake of micronutrients may lower the risk of CKD stage 3B and over, suggesting that dietary guidelines are needed in the general population to prevent CKD.

scholarly journals Years of potential life lost in pre-diabetes and diabetes mellitus: data from a 40-year follow-up of the Israel study on Glucose intolerance, Obesity and Hypertension

2021 ◽  
Vol 9 (1) ◽  
pp. e001981
Author(s):  
Micha Rapoport ◽  
Angela Chetrit ◽  
Dror Cantrell ◽  
Ilya Novikov ◽  
Jesse Roth ◽  
...  
Keyword(s):  
Glucose Intolerance ◽  
Lifestyle Modification ◽  
Smoking Status ◽  
Age Groups ◽  
Tolerance Test ◽  
High Risk Group ◽  
Oral Glucose ◽  
Average Difference ◽  
Using Data

IntroductionWe examined years of potential life lost (YPLL) associated with pre-diabetes as compared with either normoglycemia or diabetes, using data of the Israel cohort of Glucose intolerance, Obesity and Hypertension 40-year follow-up.Research design and methodsMen and women (N=2844, mean age 52.0±8.2 years) who underwent oral glucose tolerance test and anthropometric measurements, during 1976–1982, were followed for mortality until May 2019. Multiple imputation procedures for missing mortality dates and multivariable regression mixed models were applied.ResultsAt baseline, 35.8%, 48.8% and 15.4% individuals were found with normoglycemia, pre-diabetes, and diabetes, respectively. The average difference in YPLL associated with pre-diabetes as compared with normoglycemia was 4.3 years (95% CI 3.3 to 5.2; p<0.001). YPLL were 1 year higher in women with pre-diabetes than in men with pre-diabetes. These differences persisted mainly in individuals younger than 60 years, and those with body mass index (BMI) <25 kg/m2, at baseline. Adjusting for age, sex, country of origin, smoking status, BMI, and blood pressure, the average difference in YPLL associated with pre-diabetes as compared with normoglycemia was 2.0 years (95% CI 1.2 to 2.8; p<0.001). Significant reductions of 5.9 years (95% CI 4.8 to 7.0) on average were observed for diabetes as compared with pre-diabetes and 7.9 years (95% CI 6.7 to 9.1) as compared with individuals with normoglycemia.ConclusionsThis study reveals that life expectancy of middle-aged individuals with pre-diabetes is shorter than of normoglycemic ones. These findings are especially relevant in view of the rising worldwide prevalence of pre-diabetes within younger age groups and underscore the crucial importance of interventions by either lifestyle modification or drug therapy capable of delaying progression from pre-diabetes to diabetes to reduce the YPLL in this high-risk group.

Abstract P002: Heavy Alcohol Consumption Increases the Risk of Atrial Fibrillation -Circulatory Risk in Communities Study(CIRCS)

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Fumihiko Sano ◽  
Tetsuya Ohira ◽  
Akihiko Kitamura ◽  
Hironori Imano ◽  
Renzhe Cui ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Alcohol Consumption ◽  
Medical History ◽  
Moderate Alcohol Consumption ◽  
Heavy Alcohol ◽  
Ethanol Drinking ◽  
Wide Range ◽  
Detailed Medical History ◽  
Heavy Alcohol Consumption

Background— Evidence on the relationship of a wide range of alcohol consumption with risk of incident atrial fibrillation has been limited. Methods— Between 1991 and 1995, 8602 Japanese men and women aged 30 to 80 years and free of clinical atrial fibrillation took part in the first examination of the Circulatory Risk in Communities Study(CIRCS)- a population based cohort study of cardiovascular risk factors, cardiovascular disease incidence, and their trends in Japanese communities. In the first examination, we checked a detailed medical history, physical examination, blood and urine examination, and electrocardiogram (ECG). An interviewer obtained histories in detail for weekly alcohol intake. In the follow-up period, incident atrial fibrillations were ascertained by annual ECG record and medical history of treatment of atrial fibrillation. ECGs were coded with the Minnesota Code by trained physician-epidemiologists. Differences in baseline characteristics between atrial fibrillation cases and controls were compared using Student t-tests or chi-squared tests. The hazard ratios (HRs) of incidence of atrial fibrillation and 95% confidence interval (CI) relative to the never-drinking group were calculated with adjustment for age and other potential confounding factors using the Cox proportional hazard model. Results— During an average follow-up of 6.4 years, 290 incident atrial fibrillation occurred. The higher incidence rate of atrial fibrillation was observed among participants with more than 69 g of ethanol drinking per week, compared with less than 69 g of ethanol drinking per week. On the other hand, light to moderate alcohol consumption was not associated with risk of atrial fibrillation. Compared with the never drinking group, the multivariable-adjusted HRs of past, light (<23 g), light moderate (23-46 g), moderate (46-69 g), and heavy (>69 g) drinking groups were 1.20 (95% CI, 0.61-2.35), 0.85 (95% CI, 0.57-1.27), 1.05 (95% CI, 0.63-1.75), 1.34 (95% CI, 0.78-2.32), and 2.92 (95% CI, 1.61-5.28), respectively. Conclusions— Heavy alcohol consumption was associated with the higher risk of atrial fibrillation, whereas there was no association of less than moderate alcohol consumption and atrial fibrillation.

scholarly journals Studies of insulin resistance in patients with clinical and subclinical hypothyroidism

2009 ◽  
Vol 160 (5) ◽  
pp. 785-790 ◽  
Author(s):  
Eirini Maratou ◽  
Dimitrios J Hadjidakis ◽  
Anastasios Kollias ◽  
Katerina Tsegka ◽  
Melpomeni Peppa ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Plasma Membrane ◽  
Glucose Transport ◽  
Subclinical Hypothyroidism ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Model Assessment ◽  
Increased Risk

ObjectiveAlthough clinical hypothyroidism (HO) is associated with insulin resistance, there is no information on insulin action in subclinical hypothyroidism (SHO).Design and methodsTo investigate this, we assessed the sensitivity of glucose metabolism to insulin both in vivo (by an oral glucose tolerance test) and in vitro (by measuring insulin-stimulated rates of glucose transport in isolated monocytes with flow cytometry) in 21 euthyroid subjects (EU), 12 patients with HO, and 13 patients with SHO.ResultsAll three groups had comparable plasma glucose levels, with the HO and SHO having higher plasma insulin than the EU (P<0.05). Homeostasis model assessment index was increased in HO (1.97±0.22) and SHO (1.99±0.13) versus EU (1.27±0.16, P<0.05), while Matsuda index was decreased in HO (3.89±0.36) and SHO (4.26±0.48) versus EU (7.76±0.87, P<0.001), suggesting insulin resistance in both fasting and post-glucose state. At 100 μU/ml insulin: i) GLUT4 levels on the monocyte plasma membrane were decreased in both HO (215±19 mean fluorescence intensity, MFI) and SHO (218±24 MFI) versus EU (270±25 MFI, P=0.03 and 0.04 respectively), and ii) glucose transport rates in monocytes from HO (481±30 MFI) and SHO (462±19 MFI) were decreased versus EU (571±15 MFI, P=0.04 and 0.004 respectively).ConclusionsIn patients with HO and SHO: i) insulin resistance was comparable; ii) insulin-stimulated rates of glucose transport in isolated monocytes were decreased due to impaired translocation of GLUT4 glucose transporters on the plasma membrane; iii) these findings could justify the increased risk for insulin resistance-associated disorders, such as cardiovascular disease, observed in patients with HO or SHO.

scholarly journals Impact of Mobile Health Devices for the Detection of Atrial Fibrillation: Systematic Review

10.2196/26161 ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. e26161
Author(s):  
Tom E Biersteker ◽  
Martin J Schalij ◽  
Roderick W Treskes
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Mobile Health ◽  
Standard Care ◽  
Detection Rate ◽  
Increased Risk ◽  
Study Results ◽  
Statistical Heterogeneity ◽  
Study Participants

Background Atrial fibrillation (AF) is the most common arrhythmia, and its prevalence is increasing. Early diagnosis is important to reduce the risk of stroke. Mobile health (mHealth) devices, such as single-lead electrocardiogram (ECG) devices, have been introduced to the worldwide consumer market over the past decade. Recent studies have assessed the usability of these devices for detection of AF, but it remains unclear if the use of mHealth devices leads to a higher AF detection rate. Objective The goal of the research was to conduct a systematic review of the diagnostic detection rate of AF by mHealth devices compared with traditional outpatient follow-up. Study participants were aged 16 years or older and had an increased risk for an arrhythmia and an indication for ECG follow-up—for instance, after catheter ablation or presentation to the emergency department with palpitations or (near) syncope. The intervention was the use of an mHealth device, defined as a novel device for the diagnosis of rhythm disturbances, either a handheld electronic device or a patch-like device worn on the patient’s chest. Control was standard (traditional) outpatient care, defined as follow-up via general practitioner or regular outpatient clinic visits with a standard 12-lead ECG or Holter monitoring. The main outcome measures were the odds ratio (OR) of AF detection rates. Methods Two reviewers screened the search results, extracted data, and performed a risk of bias assessment. A heterogeneity analysis was performed, forest plot made to summarize the results of the individual studies, and albatross plot made to allow the P values to be interpreted in the context of the study sample size. Results A total of 3384 articles were identified after a database search, and 14 studies with a 4617 study participants were selected. All studies but one showed a higher AF detection rate in the mHealth group compared with the control group (OR 1.00-35.71), with all RCTs showing statistically significant increases of AF detection (OR 1.54-19.16). Statistical heterogeneity between studies was considerable, with a Q of 34.1 and an I2 of 61.9, and therefore it was decided to not pool the results into a meta-analysis. Conclusions Although the results of 13 of 14 studies support the effectiveness of mHealth interventions compared with standard care, study results could not be pooled due to considerable clinical and statistical heterogeneity. However, smartphone-connectable ECG devices provide patients with the ability to document a rhythm disturbance more easily than with standard care, which may increase empowerment and engagement with regard to their illness. Clinicians must beware of overdiagnosis of AF, as it is not yet clear when an mHealth-detected episode of AF must be deemed significant.

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