Self-Monitoring for AF Are we There Yet 4_Dr. Ngai-yin CHAN.pdf · Tools for AF Screening McManus...

Self-Monitoring for AF –

Are we There Yet ?

Dr Ngai-Yin Chan, MBBS, FRCP(Edin, Glasg, Lond), FACC, FHRS,

Consultant Physician,

Department of Medicine & Geriatrics,

Princess Margaret Hospital.

Clinical Associate Professor (Hon),

Department of Medicine & Therapeutics, Chinese University of Hong Kong,

Hong Kong

APCCRC 2016, November 6 2016, Hong Kong

Tools for AF Screening

McManus DD et al. PULSE-SMART: pulse-based arrhythmia discrimination using a novel smartphone application

JCE 2016;27:51-7


Chan PH et al. Diagnostic performance of a smartphone-based photoplethysmographic application for AF screening

In a primary care setting. JAHA 2016;5:e003428

Prevalence and Incidence of AF

Schnabel RB et al. 50 years trends in AF prevalence, incidence, risk factors and mortality in the Framingham Heart

Study: a cohort study. Lancet 2015;386:154-62.

Analysis of the Framingham

cohort over 50 years

202417 person-years FU

over 50 years

Complications of AF

Healey JS et al. Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation:

A cohort study. Lancet 2016;388:1161-9

Prospective registry

N=15400 from 47 countries

admitted with AF or atrial

flutter as primary or

secondary diagnosis

FU 1 year for occurrence of

death and strokes

15361 completed FU, 1758

(11%) died within 1 year

Stroke Prevention in AF by Warfarin

Hart GH et al. Metaanalysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular AF.

Ann Intern Med 2007;146:857-67

Meta-analysis of 29 RCT’s testing antithrombotic drugs in non-valvular AF

N=28044 participants

Stroke Prevention in AF by Warfarin

Hart GH et al. Metaanalysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular AF.

Ann Intern Med 2007;146:857-67

NOAC vs Warfarin-Stroke or

Systemic Embolism

Ruff CT et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial

Fibrillation: a metaanalysis of randomised trials. Lancet 2014;383:955-62

Metaanalysis of 4 RCTs comparing NOAC’s with warfarin (RE-LY, ROCKET AF, ARISTOTLE,

ENGAGE AF-TIMI 48)

N=71683, 42411 received a NOAC, 29272 received warfarin

NOAC reduced stroke or systemic embolism by 19% (51% reduction in haemorrhagic stroke), death

by 10%

NOAC vs Warfarin-Major

Bleeding



NOAC vs Warfarin-GI Bleeding



Checkpoints in Stroke Prevention

in AF

Diagnosis

of AF

Seek

Medical

Attention

OAC

Prescribed

Compliance

Asymptomatic AF-Prognosis

Siontis KC et al. Typical, atypical and asymptomatic presentations of new-onset AF in the community: characteristics

And prognostic implications. HR 2016;13:1418-24

N=476 patients with incident AF in Olmsted County, Minnesota, were randomly selected (2000-10)

193 had typical (palpitations), 122 had atypical and 161 (34%) had asymptomatic AF presentations

59 strokes and 149 deaths (49 cardiovascular) documented over a median of 5.6-6 years

Asymptomatic AF-Prognosis

Siontis KC et al. Typical, atypical and asymptomatic presentations of new-onset AF in the community: characteristics

And prognostic implications. HR 2016;13:1418-24

European Guidelines for AF Screening

Kirchhof P et al. 2016 ESC guidelines for the

management of AF developed in collaboration

with EACTS. EHJ 2016;37:2893-1962.

Community Screening for AF

With Smartphone ECG

Chan NY et al. Screening for atrial fibrillation in 13122 Hong Kong citizens with smartphone electrocardiogram.

Heart 2016 Oct 12 [Epub ahead of print]

AF shown by smartphone ECG

No AF shown by smartphone ECG

239/13122 (1.8%)

Newly detected AF by smartphone ECG

No AF plus known AF

101/13122 (0.8%)

N=13122 Hong Kong citizens screened for AF with a smartphone ECG in the period between May 1 2014

and April 30 2015 Smartphone ECG was performed by trained non-medical volunteers; uninterpretable ECG’s 56/13122 (0.4%)

NNT = 125

Symptom Status in Newly-

diagnosed AF



Asymptomatic Symptomatic

66/101 (65%)

Predictors for Newly-diagnosed AF



When a cut-off age threshold of 60 or above was used, there was a 98% sensitivity and 29%

specificity in detecting newly-diagnosed AF

Telephone Survey on AF Awareness and

Acceptance of E-health Technology

Telephone survey conducted on June 14-17 2016

Target respondents: Hong Kong citizens aged 18 or

above

N=810

Chan NY et al. Asia-Pacific AF Awareness Month Press conference [unpublished data]



Men Women

473 (58%)

Age<65 Age 65 or above

337 (42%)

615 (76%)

195 (24%)


0

20

40

60

80

100

<65 ≥65 All



Age

49%

40%

47%

P=0.064

Will you use a hand-held equipment together

with a smartphone app to check your heart beat ?

%


0

20

40

60

80

100

<65 ≥65 All

Will you use a hand-held equipment together

with a smartphone app to check the heart beat of

your family members ?



%

57%

39%

52%

P<0.001

Age


Conclusions

Asymptomatic AF is common and may even be

prognostically worse than symptomatic AF;

screening for early detection and treatment of AF

is thus necessary

E-health technology, especially those

smartphone-based, has made community AF

screening and possibly self-monitoring for AF

feasible

Conclusions

Community screening for AF with a

smartphone-based wireless single-lead ECG is

feasible and is capable of identifying a sizable

proportion of patients with newly-diagnosed AF

The acceptance of self-monitoring for heart

rhythm disorders with a smartphone-based

device is remarkably high; whether it is feasible

and can translate into a reduction in the stroke

burden due to AF in the community requires

further research

Self-Monitoring for AF Are we There Yet 4_Dr. Ngai-yin CHAN.pdf · Tools for AF Screening McManus...

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