Consumer-Led Screening for Atrial Fibrillation : Frontier Review of the AF-SCREEN International Collaboration
(2022) In Circulation 146(19). p.1461-1474- Abstract
The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional-led randomized controlled studies using... (More)
The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional-led randomized controlled studies using multiple ECG recordings or continuous ECG monitoring to detect AF have failed to demonstrate a significant reduction in stroke. Although it remains uncertain if consumer-led AF screening reduces stroke, it could increase early diagnosis of AF and facilitate an integrated approach, including appropriate anticoagulation, rate or rhythm management, and risk factor modification to reduce complications. Companies marketing AF screening devices should report the accuracy and performance of their products in high- and low-risk populations and avoid claims about clinical outcomes unless improvement is demonstrated in randomized clinical trials. Generally, the diagnostic yield of AF screening increases with the number, duration, and temporal dispersion of screening sessions, but the prognostic importance may be less than for AF detected by single-time point screening, which is largely permanent, persistent, or high-burden paroxysmal AF. Consumer-initiated ECG recordings suggesting possible AF always require confirmation by a health care professional experienced in ECG reading, whereas suspicion of AF on the basis of photoplethysmography must be confirmed with an ECG. Consumer-led AF screening is unlikely to be cost-effective for stroke prevention in the predominantly young, early adopters of this technology. Studies in older people at higher stroke risk are required to demonstrate both effectiveness and cost-effectiveness. The direct interaction between companies and consumers creates new regulatory gaps in relation to data privacy and the registration of consumer apps and devices. Although several barriers for optimal use of consumer-led screening exist, results of large, ongoing trials, powered to detect clinical outcomes, are required before health care professionals should support widespread adoption of consumer-led AF screening.
(Less)
- author
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- atrial fibrillation, screening, wearable electronic devices
- in
- Circulation
- volume
- 146
- issue
- 19
- pages
- 14 pages
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- scopus:85141366900
- pmid:36343103
- ISSN
- 0009-7322
- DOI
- 10.1161/CIRCULATIONAHA.121.058911
- language
- English
- LU publication?
- yes
- id
- bf5d9855-829f-4371-988b-0cfb3a7a4abd
- date added to LUP
- 2022-12-06 10:02:33
- date last changed
- 2024-12-14 19:01:49
@article{bf5d9855-829f-4371-988b-0cfb3a7a4abd,
abstract = {{<p>The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional-led randomized controlled studies using multiple ECG recordings or continuous ECG monitoring to detect AF have failed to demonstrate a significant reduction in stroke. Although it remains uncertain if consumer-led AF screening reduces stroke, it could increase early diagnosis of AF and facilitate an integrated approach, including appropriate anticoagulation, rate or rhythm management, and risk factor modification to reduce complications. Companies marketing AF screening devices should report the accuracy and performance of their products in high- and low-risk populations and avoid claims about clinical outcomes unless improvement is demonstrated in randomized clinical trials. Generally, the diagnostic yield of AF screening increases with the number, duration, and temporal dispersion of screening sessions, but the prognostic importance may be less than for AF detected by single-time point screening, which is largely permanent, persistent, or high-burden paroxysmal AF. Consumer-initiated ECG recordings suggesting possible AF always require confirmation by a health care professional experienced in ECG reading, whereas suspicion of AF on the basis of photoplethysmography must be confirmed with an ECG. Consumer-led AF screening is unlikely to be cost-effective for stroke prevention in the predominantly young, early adopters of this technology. Studies in older people at higher stroke risk are required to demonstrate both effectiveness and cost-effectiveness. The direct interaction between companies and consumers creates new regulatory gaps in relation to data privacy and the registration of consumer apps and devices. Although several barriers for optimal use of consumer-led screening exist, results of large, ongoing trials, powered to detect clinical outcomes, are required before health care professionals should support widespread adoption of consumer-led AF screening.</p>}},
author = {{Brandes, Axel and Stavrakis, Stavros and Freedman, Ben and Antoniou, Sotiris and Boriani, Giuseppe and Camm, A. John and Chow, Clara K. and Ding, Eric and Engdahl, Johan and Gibson, Michael M. and Golovchiner, Gregory and Glotzer, Taya and Guo, Yutao and Healey, Jeff S. and Hills, Mellanie T. and Johnson, Linda and Lip, Gregory Y.H. and Lobban, Trudie and MacFarlane, Peter W. and Marcus, Gregory M. and McManus, David D. and Neubeck, Lis and Orchard, Jessica and Perez, Marco V. and Schnabel, Renate B. and Smyth, Breda and Steinhubl, Steven and Turakhia, Mintu P.}},
issn = {{0009-7322}},
keywords = {{atrial fibrillation; screening; wearable electronic devices}},
language = {{eng}},
number = {{19}},
pages = {{1461--1474}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Circulation}},
title = {{Consumer-Led Screening for Atrial Fibrillation : Frontier Review of the AF-SCREEN International Collaboration}},
url = {{http://dx.doi.org/10.1161/CIRCULATIONAHA.121.058911}},
doi = {{10.1161/CIRCULATIONAHA.121.058911}},
volume = {{146}},
year = {{2022}},
}