High-Risk Atrial Fibrillation Diagnosis Facilitated by Home-Based ECG
Active ECG monitoring was associated with a higher rate of anticoagulant therapy initiation and greater use of healthcare resources.
Individuals at high risk for atrial fibrillation (AF) who wore a self-applied continuous electrocardiogram (ECG) monitoring patch at home had higher rates of AF diagnosis, greater initiation of anticoagulant therapy, and increased healthcare resource utilization, according to the results of a study published in the Journal of the American Medical Association.
Patients with high-risk AF were randomly assigned into one of two active groups receiving either immediate home-based ECG monitoring or delayed home-based ECG monitoring after 4 months. Diagnosis rates of AF, use of anticoagulants, and healthcare resource utilization were compared between groups after 1 year. A routine care, observational cohort had 2 matched controls for each patient in the actively monitored groups of the study.
Of the 2659 patients in the active component of the study, the resulting group sizes following randomization were 1366 in the immediate monitoring group and 1293 in the delayed monitoring group. The observational cohort comprised 5318 matched controls.
The incidence of newly diagnosed AF after 1 year in the immediate monitoring group was 3.9% compared with 0.9% in the delayed monitoring group. Active monitoring was also associated with a higher rate of anticoagulant therapy initiation (5.7 vs 3.7 per 100 person-years; absolute difference, 2.0 [95% CI, 1.9-22]) and greater use of healthcare resources, including outpatient cardiology visits (33.5 vs 26.0 per 100 person-years; difference, 7.5 [95% CI, 7.2-7.9]) and primary care visits (83.5 vs 82.6 per 100 person-years; difference, 0.9 [95% CI, 0.4-1.5]).
The researchers noted the clinical importance of these findings: “These results suggest that spot checking for AF, whether by a random pulse check for irregularity or obtaining a brief ECG, would likely miss most individuals with undiagnosed AF.”
Steinhubl S, Waalen J, Edwards A, et al. Effect of a home-based wearable continuous ECG monitoring patch on detection of undiagnosed atrial fibrillation: the mSToPS randomized clinical trial. JAMA. 2018;320(2):146-155.