Direct-to-consumer detection of atrial fibrillation in a smartwatch electrocardiogram: Medical overuse, medicalisation and the experience of consumers

Shih, Patti; Prokopovich, Kathleen; Degeling, Chris; Street, Jackie; Carter, Stacy M

doi:10.1016/j.socscimed.2022.114954

Cited by 12 publications

(9 citation statements)

References 32 publications

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“…The largest target of DTC tests though are consumers who are healthy and asymptomatic, providing an untapped market for these products 44. Over 40% of the tests found in this study aim to assess a range of normal, everyday functions such as sleep, ageing, physical activity and hormone levels.…”

Section: Discussionmentioning

confidence: 99%

Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility

Shih,

Ding,

Carter

et al. 2023

BMJ Open

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ObjectivesThe objective of this study is to map the range and variety of direct-to-consumer (DTC) tests advertised online in Australia and analyse their potential clinical utility and implications for medical overuse.DesignSystematic online search of DTC test products in Google and Google Shopping. DTC test advertisements data were collected and analysed to develop a typology of potential clinical utility of the tests at population level, assessing their potential benefits and harms using available evidence, informed by concepts of medical overuse.ResultsWe identified 484 DTC tests (103 unique products), ranging from $A12.99 to $A1947 in cost (mean $A197.83; median $A148.50). Using our typology, we assigned the tests into one of four categories: tests with potential clinical utility (10.7%); tests with limited clinical utility (30.6%); non-evidence-based commercial ‘health checks’ (41.9%); and tests whose methods and/or target conditions are not recognised by the general medical community (16.7%). Of the products identified, 56% did not state that they offered pretest or post-test consultation, and 51% did not report analytical performance of the test or laboratory accreditation.ConclusionsThis first-in-Australia study shows most DTC tests sold online have low potential clinical utility, with healthy consumers constituting the main target market. Harms may be caused by overdiagnosis, high rates of false positives and treatment decisions led by non-evidence-based tests, as well as financial costs of unnecessary and inappropriate testing. Regulatory mechanisms should demand a higher standard of evidence of clinical utility and efficacy for DTC tests. Better transparency and reporting of health outcomes, and the development of decision-support resources for consumers are needed.

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Section: Discussionmentioning

confidence: 99%

Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility

Shih,

Ding,

Carter

et al. 2023

BMJ Open

Self Cite

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“…There is a disconnect between medical regulation and level of trust placed in smartwatch applications by consumers. Taking the example of the Apple Watch electrocardiogram, a recent qualitative study found brand loyalty and marketing were a greater influence on using the app than its status as medical device software 26 …”

Section: Not the Right Time: Current Challenges For Smartwatch Integr...mentioning

confidence: 99%

“…Taking the example of the Apple Watch electrocardiogram, a recent qualitative study found brand loyalty and marketing were a greater influence on using the app than its status as medical device software. 26 There is no formal training or incentive for clinicians to interpret vast amounts of data generated by smartwatches. Questions also remain surrounding data ownership, storage and accessibility -data protection laws must ensure that medical data are not misused and only necessary data collected with informed consent.…”

Section: Not the Right Time: Current Challenges For Smartwatch Integr...mentioning

confidence: 99%

A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care

Mattison

Forrester

Dobbins

et al. 2023

Medical Journal of Australia

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A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care Smartwatches can count every step towards a predict-prevent health care system, but clinical regulation is the first leap A ustralia is struggling with the ever-increasing burden of chronic disease. Over $38 billion per year is spent on care for people with chronic diseases, such as cardiovascular disease, type 2 diabetes, and cancer. 1 The majority of this funding is dedicated to acute care, and just 9.6% of health care investment supports disease prevention. 1 Perversely, Australia's health system is rewarded for increasing acute care activity (activity-based funding) to manage disease, which perpetuates inefficient break-fix models of care. 2 The strain on acute care service provision has been accelerated by the COVID-19 pandemic 3 and Australia's ageing population, and is forecast as unsustainable. 2 Ageing increases total expenditure on hospitalisations, pathology provision, medical imaging, and cost to the Pharmaceutical Benefits Scheme. 1 This burden of chronic diseaseassociated with disability and premature death -is becoming less and less sensitive to further extensions in health care spending on treatment. Prevention (as defined in the Supporting Information) is urgently needed; however, dedicated funding, policies and models of preventive care for chronic diseases in communities are minimal, especially for priority populations and high risk social and environmental settings. Digital medicine can enable efficient predictprevent models of health care

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“…14 In the present study, the PAC/24 h the day after the second procedure was significantly decreased in both groups with and without PV reconnection (Figure 4). Although the true origin of PACs triggering the AF is undetectable because it can be provoked by multiple triggers not only by PV but also in other sites, 29,30 the PAC burden after the procedure might also be a surrogate marker of remaining arrhythmogenicity. The second procedure can reduce them.…”

Section: Behavior Of Pac After Rfcamentioning

confidence: 99%

“…Furthermore, adding the PAC/24 h after the procedure appeared to correctly reclassify patients who were thought to be in the group at high risk for recurrence based on the model of LA enlargement into the low-risk group and vice versa. Indeed, advanced long-term monitoring devices, including long-term loop recorders, smartwatch electrocardiograms, or implantable cardiac monitors, 9,30 can provide a more detailed information for predicting late recurrence; however, the follow-up of all patients is difficult using these devices because these are complicated, time-consuming, and expensive. We considered that a Holter monitoring immediately after the procedure is a simple screening tool for risk stratification of late recurrence.…”

Section: Clinical Implicationmentioning

confidence: 99%

Premature atrial contraction immediately after catheter ablation was associated with late recurrence of atrial fibrillation

Fujisawa

Kawakami

Nagai

et al. 2022

Pacing Clinical Electrophis

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Background Although premature atrial contractions (PACs) just after catheter ablation (CA) for atrial fibrillation (AF) are common, their clinical significance is uncertain. This study aimed to evaluate whether the PAC burden after an initial CA for AF was associated with late recurrence. Methods We enrolled 346 patients with AF (median age, 65 years; 30% female; 57% with paroxysmal AF) who underwent an initial radiofrequency CA and a 24‐h Holter monitoring the day after the procedure. PAC was defined as supraventricular complexes occurring ≥30% earlier than expected compared with a previous RR interval, and the number of PAC/24 h during post‐procedural Holter monitoring was analyzed. Results AF recurred in 106 patients (31%) during a median follow‐up of 19 months. These patients had significantly more PAC/24 h than those without (median [interquartile range], 891 [316–4351] beats vs. 409 [162–1,303] beats; p < 0.01). The number of PACs was independently associated with AF recurrence after adjustment for clinical parameters and left atrial (LA) enlargement. Receiver operating characteristic (ROC) curve analysis revealed that 1431 PAC/24 h was the optimal cut‐off value for predicting AF recurrence. Adding the PAC/24 h to the prediction model with LA diameter appeared to correctly reclassify patients who were thought to be at high risk for AF recurrence into the low‐risk group and vice versa. Conclusions The number of PACs was an independent risk factor for AF recurrence. A 24‐h Holter recording the day after an initial CA is a simple and beneficial tool for the risk stratification of AF recurrence.

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Direct-to-consumer detection of atrial fibrillation in a smartwatch electrocardiogram: Medical overuse, medicalisation and the experience of consumers

Cited by 12 publications

References 32 publications

Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility

Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility

A step in the right direction: the potential role of smartwatches in supporting chronic disease prevention in health care

Premature atrial contraction immediately after catheter ablation was associated with late recurrence of atrial fibrillation

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