NICE atrial fibrillation guideline snubs wearable technology: a missed opportunity?

Gala, Andre Briosa e; Pope, Michael; Leo, Milena; Lobban, Trudie; Betts, Timothy R.

doi:10.7861/clinmed.2021-0436

Cited by 9 publications

(4 citation statements)

References 29 publications

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“…For example, the European Society of Cardiology (ESC) had recommended wearable technology in AF screening (65), but the National Institute for Health and Care Excellence (NICE) did not (66). Undoubtedly, there are many challenges and barriers to adoption of WEDs for practitioners and rigorous studies are warranted (67). It will be beneficial to adoption and promotion if the researchers can provide high-quality evidence for diagnostic performance.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting wearable ECG device adoption by general practitioners for atrial fibrillation screening: cross-sectional study

Yao

et al. 2023

Front. Public Health

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IntroductionAtrial fibrillation (AF) is a challenging cardiovascular disease worldwide. Wearable electrocardiograph devices (WEDs) have great potential to improve the detection rate of AF in primary care. However, the factors that influence general practitioners’ (GPs) perception and acceptance of WEDs are not well understood. To identify factors that influence the intention of GPs to utilize WEDs in a clinical setting to screen patients for AF.MethodThe research hypotheses and questionnaire items were designed and developed based on the unified theory of acceptance and technology (UTAUT) framework. We used stratified sampling and obtained the data through an online survey. Structural equation modeling was used to analyze the collected data.Results: A total of 1,004 valid questionnaires from GPs across Sichuan province in China were collected. Three factors increased GPs’ intention to utilize WEDs to screen patients for AF, including performance expectancy (β = 0.121, p = 0.004), social influence (β = 0.356, p < 0.001), and price perception (β = 0.587, p < 0.001). Perception risk (β = −0.059, p < 0.001) decreased usage intention, while effort expectancy (β = −0.079, p = 0.155) and facilitating conditions (β = −0.014, p = 0.868) did not affect usage intention. Gender (β = −0.022, p = 0.179), age (β = 0.006, p = 0.699), education level (β = −0.22, p = 0.184) and training (β = 0.007, p = 0.69) were not significantly correlated with usage intention, and these four factors had no moderating effect on the path coefficients.DiscussionGPs’ intention to utilize WEDs is affected by performance expectancy, price perception, perception risk and social influence. Researcher should improve the usability and perception of WEDs for screening and carry out studies to provide high-quality evidence for the security and efficacy of wearable devices.

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Section: Discussionmentioning

confidence: 99%

Factors affecting wearable ECG device adoption by general practitioners for atrial fibrillation screening: cross-sectional study

Yao

et al. 2023

Front. Public Health

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“… 1 However, the National Institute of Clinical Excellence in the UK has not yet recommended the use of wearables in their recent AF diagnosis and management guideline (NG196) despite Public Health England sponsoring initiatives to promote the use of wearable technologies. 11 …”

Section: Introductionmentioning

confidence: 99%

Remote monitoring of atrial fibrillation recurrence using mHealth technology (REMOTE-AF)

Adasuriya,

Barsky,

Kralj-Hans

et al. 2024

European Heart Journal - Digital Health

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Background and Aims This proof-of-concept study sought to evaluate changes in heart rate (HR) obtained from a consumer wearable device and compare against implanted loop recorder (ILR)-detected recurrence of atrial fibrillation (AF) and atrial tachycardia (AT) after AF ablation. Methods REMOTE-AF (NCT05037136) was a prospectively designed sub study of the CASA-AF randomised controlled trial (NCT04280042). Participants without a permanent pacemaker had an implantable loop recorder (ILR) implanted at their index ablation procedure for longstanding persistent atrial fibrillation. HR and step count were continuously monitored using photoplethysmography (PPG) from a commercially available wrist-worn wearable. PPG recorded HR data was pre-processed with noise filtration and episodes at 1-minute intervals over 30 minutes of heart rate elevations (Z-score = 2) were compared to corresponding ILR data. Results Thirty-five patients were enrolled, with mean age 70.3 +/- 6.8 yrs and median follow-up 10 months (IQR 8-12 months). ILR analysis revealed seventeen out of thirty-five patients (49%) had recurrence of AF/AT. Compared with ILR recurrence, wearable-derived elevations in HR ≥ 110 beats per minute had a sensitivity of 95.3%, specificity 54.1%, positive predictive value (PPV) 15.8%, negative predictive value (NPV) 99.2% and overall accuracy 57.4%. With PPG recorded HR elevation spikes (non-exercise related), the sensitivity was 87.5%, specificity 62.2%, PPV 39.2%, NPV 92.3% and overall accuracy 64.0% in the entire patient cohort. In the AF/AT recurrence only group, sensitivity was 87.6%, specificity 68.3%, PPV 53.6%, NPV 93.0% and overall accuracy 75.0%. Conclusion Consumer wearable devices have the potential to contribute to arrhythmia detection after AF ablation.

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“…10 Health England (PHE) sponsoring initiatives to promote the use of wearable technologies. 11 A multitude of research studies have assessed the ability of PPG to screen for asymptomatic or index AF, however there is a paucity of data identifying recurrence of AF post rhythm control intervention. Our study sought to evaluate the correlation between a novel composite of wearable device recorded data with ILR (Reveal LINQ™) detected AF/AT recurrence in a cohort of patients who had undergone an AF ablation procedure for LSPAF.…”

Section: Introductionmentioning

confidence: 99%

Remote Monitoring of AF Recurrence using mHealth Technology (REMOTE-AF)

Adasuriya

Barsky

Kralj-Hans

et al. 2023

Preprint

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Background: Atrial Fibrillation (AF) detection tools have rapidly developed over the last decade alongside the evolution of mobile health (mHealth) monitoring. mHealth wearable technologies have been hypothesised to be a potential non-invasive and near continuous modality for long term detection and monitoring of atrial arrhythmias. We conducted a proof-of-concept study to evaluate changes in heart rate obtained from a consumer wearable device and compare against implanted loop recorder (ILR)-detected recurrence of AF and atrial tachycardia (AT) after AF ablation. Methods: REMOTE-AF (Remote Monitoring of AF Recurrence Using mHealth Technology;NCT05037136) was a prospectively designed sub study of the CASA-AF randomised controlled trial (NCT04280042). Participants without a permanent pacemaker had an ILR implanted at their index ablation procedure (catheter vs thoracoscopic) for longstanding persistent AF. Heart rate (HR) and step count were continuously monitored using a wrist-worn wearable device connected to a smartphone. Photoplethysmography (PPG) recorded HR data was pre-processed with noise filtration and episodes at 1 -minute intervals over 30 minutes of HR elevations (Z-score = 2) were compared to corresponding ILR data. Arrhythmias detected by ILR were validated by an independent cardiac physiologist. The AF Effect on Quality of Life (AFEQT) questionnaire was completed by participants at baseline and at the conclusion of the study. Results: Thirty-five patients were enrolled, with mean age 70.3 +/- 6.8 yrs, 12 (34%) women, and median follow-up 10 months (IQR 8-12 months). ILR analysis revealed 17 out of 35 patients (49%) had recurrence of AF/AT. Compared with ILR recurrence, wearable-derived elevations in HR ≥ 110 beats per minute had a sensitivity of 95.3%, specificity 54.1%, positive predictive value (PPV) 15.8%, negative predictive value (NPV) 99.2% and overall accuracy 57.4%. With PPG recorded HR elevation spikes (non-exercise related), the sensitivity was 87.5%, specificity 62.2%, PPV 39.2%, NPV 92.3% and overall accuracy 64.0% in the entire patient cohort. In the AF/AT recurrence only group, sensitivity was 87.6%, specificity 68.3%, PPV 53.6%, NPV 93.0% and overall accuracy 75.0%. Conclusion: Consumer wearable devices have the potential to contribute to arrhythmia detection after AF ablation, but further work is needed to improve and validate new composite detection algorithms.

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NICE atrial fibrillation guideline snubs wearable technology: a missed opportunity?

Cited by 9 publications

References 29 publications

Factors affecting wearable ECG device adoption by general practitioners for atrial fibrillation screening: cross-sectional study

Factors affecting wearable ECG device adoption by general practitioners for atrial fibrillation screening: cross-sectional study

Remote monitoring of atrial fibrillation recurrence using mHealth technology (REMOTE-AF)

Remote Monitoring of AF Recurrence using mHealth Technology (REMOTE-AF)

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