In the JournalsPerspective

Handheld device shows promise for detecting atrial fibrillation

A screening tool demonstrated high sensitivity for detecting atrial fibrillation among more than 1,500 adults in Brazil who were referred for an echocardiogram, according to a study published in Heart.

Researchers said MyDiagnostick (Applied Biomedical Systems) is a handheld, rod-shaped metal device with sensible electrodes on both ends and an indicator light that alerts physicians to atrial fibrillation. The single-lead device is more than 10 times cheaper than a standard smartwatch, they added. A company representative told Healio Primary Care that MyDiagnostick costs 550 euros (or approximately $604) plus shipping and administrative costs.

A previously published report in PLoS One indicated that atrial fibrillation is the most common sustained heart arrhythmia, associated with an approximately fivefold increase in stroke. More than 46 million patients worldwide have atrial fibrillation, and there are nearly 4 million new cases diagnosed each year. The PLoS One report also indicated that both U.S. and European guidelines recommend diagnosing atrial fibrillation based on a 12-lead ECG. However, the 12-lead ECG use for atrial fibrillation in primary care has not been proven cost-effective, regardless of a patient’s risk for the condition.

In the new study, Adriana C. Diamantino, MD, of the Hospital das Clinicas da Universidade Federal de Minas Gerais in Brazil, and colleagues wrote that evidence shows smartwatches have good accuracy in diagnosing atrial fibrillation. However, because smartwatches are cost-prohibitive for some patients, they wanted to determine the accuracy of MyDiagnostick.

Diamantino AC, et al. Heart. 2020;doi:10.1136/heartjnl-2019.316277.

Diamantino and colleagues performed clinical evaluation of 1,518 patients (mean age, 58 years; 66% women), who were stratified by CV risk. The authors indicated that the hand-held device detected a high risk for atrial fibrillation in 12.6% of the cohort, intermediate risk in 6.1% of the cohort and a low risk in 2.2% of the cohort. When an echocardiogram was used to verify risk, a positive indication of atrial fibrillation via the device was independently associated with heart disease (OR = 3.9; 95% CI, 2.1-7.2). The device also had sensitivity of 90.2% (95% CI, 77-97.3) and specificity of 84% (95% CI, 79.3-88) for detecting atrial fibrillation vs. a 12-lead ECG.

The results suggest that MyDiagnostick “may be a promising screening tool, for both early atrial fibrillation diagnosis and prioritization for cardiology referrals in under-resourced health systems,” Diamantino and colleagues wrote. – by Janel Miller

References:

Diamantino AC, et al. Heart. 2020;doi:10.1136/heartjnl-2019.316277.

Hill NR, et al. 2019;doi:10.1371/journal.pone.0224582.

Disclosures: The authors report no relevant financial disclosures.

A screening tool demonstrated high sensitivity for detecting atrial fibrillation among more than 1,500 adults in Brazil who were referred for an echocardiogram, according to a study published in Heart.

Researchers said MyDiagnostick (Applied Biomedical Systems) is a handheld, rod-shaped metal device with sensible electrodes on both ends and an indicator light that alerts physicians to atrial fibrillation. The single-lead device is more than 10 times cheaper than a standard smartwatch, they added. A company representative told Healio Primary Care that MyDiagnostick costs 550 euros (or approximately $604) plus shipping and administrative costs.

A previously published report in PLoS One indicated that atrial fibrillation is the most common sustained heart arrhythmia, associated with an approximately fivefold increase in stroke. More than 46 million patients worldwide have atrial fibrillation, and there are nearly 4 million new cases diagnosed each year. The PLoS One report also indicated that both U.S. and European guidelines recommend diagnosing atrial fibrillation based on a 12-lead ECG. However, the 12-lead ECG use for atrial fibrillation in primary care has not been proven cost-effective, regardless of a patient’s risk for the condition.

In the new study, Adriana C. Diamantino, MD, of the Hospital das Clinicas da Universidade Federal de Minas Gerais in Brazil, and colleagues wrote that evidence shows smartwatches have good accuracy in diagnosing atrial fibrillation. However, because smartwatches are cost-prohibitive for some patients, they wanted to determine the accuracy of MyDiagnostick.

Diamantino AC, et al. Heart. 2020;doi:10.1136/heartjnl-2019.316277.

Diamantino and colleagues performed clinical evaluation of 1,518 patients (mean age, 58 years; 66% women), who were stratified by CV risk. The authors indicated that the hand-held device detected a high risk for atrial fibrillation in 12.6% of the cohort, intermediate risk in 6.1% of the cohort and a low risk in 2.2% of the cohort. When an echocardiogram was used to verify risk, a positive indication of atrial fibrillation via the device was independently associated with heart disease (OR = 3.9; 95% CI, 2.1-7.2). The device also had sensitivity of 90.2% (95% CI, 77-97.3) and specificity of 84% (95% CI, 79.3-88) for detecting atrial fibrillation vs. a 12-lead ECG.

The results suggest that MyDiagnostick “may be a promising screening tool, for both early atrial fibrillation diagnosis and prioritization for cardiology referrals in under-resourced health systems,” Diamantino and colleagues wrote. – by Janel Miller

References:

Diamantino AC, et al. Heart. 2020;doi:10.1136/heartjnl-2019.316277.

Hill NR, et al. 2019;doi:10.1371/journal.pone.0224582.

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Muhammad Afzal

    Muhammad Afzal

    ECGs remain the most reliable tool for PCPs to diagnose atrial fibrillation. However, busier clinics may not have time to utilize an ECG simply based on patient suspicion of atrial fibrillation.

    Tools like MyDiagnostick are useful in confirming or denying the patient’s suspicions, but it is important to note there is currently no way to reimburse patients or physicians for using devices like MyDiagnostick. Besides that device, Kardia (AliveCor) and the Apple Watch are very good and perform similarly in the detection of atrial fibrillation in various populations [but come with the same financial caveat].

    • Muhammad Afzal, MBBS
    • Electrophysiologist, The Ohio State University Wexner Medical Center

    Disclosures: Afzal reports no relevant financial disclosures.

    Perspective
    Raj Khandwalla

    Raj Khandwalla

    Atrial fibrillation is often the first sign of many heart diseases, like congestive heart failure, coronary artery disease, vascular disease and pulmonary hypertension. It can also foreshadow hyperthyroidism, sepsis and, in rare instances, even cancer.  Most important, atrial fibrillation is associated with strokes.   Therefore, detecting atrial fibrillation early is critical, as it can help patients live longer, prevent strokes, and may even decrease healthcare costs in the long run. 

    This study shows that MyDiagnostick is effective for screening atrial fibrillation in a population of patients and helped to identify patients with other types of heart disease.  As the authors noted, MyDiagnostick is also far cheaper than other devices that screen for atrial fibrillation, such as the smartwatch. It’s also worth mentioning that smartwatches empower individuals to monitor their own heart rate while physicians or even non trained health-workers can use MyDiagnostick among many patients, perhaps enabling the widespread use of the device across a population of patients.

    • Raj Khandwalla, MD
    • Director of digital therapeutics, Smidt Heart Institute
      Director of cardiovascular education, Cedars-Sinai Medical Care Foundation
      Assistant Professor, Cedars Sinai Medical Center

    Disclosures: Khandwalla reports consulting for Biofourmis.