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Consumer-Led Screening for Atrial Fibrillation: Frontier Review of the AF-SCREEN International Collaboration

Brandes, Axel; Stavrakis, Stavros; Freedman, Ben; Antoniou, Sotiris; Boriani, Giuseppe; Camm, A. John; Chow, Clara K.; Ding, Eric; Engdahl, Johan; Gibson, Michael M.; Golovchiner, Gregory; Glotzer, Taya; Guo, Yutao; Healey, Jeff S.; Hills, Mellanie T.; Johnson, Linda; Lip, Gregory Y. H.; Lobban, Trudie; Macfarlane, Peter W.; Marcus, Gregory M.; McManus, David D.; Neubeck, Lis; Orchard, Jessica; Perez, Marco V.; Schnabel, Renate B.; Smyth, Breda; Steinhubl, Steven; Turakhia, Mintu P.

Authors

Axel Brandes

Stavros Stavrakis

Ben Freedman

Sotiris Antoniou

Giuseppe Boriani

A. John Camm

Clara K. Chow

Eric Ding

Johan Engdahl

Michael M. Gibson

Gregory Golovchiner

Taya Glotzer

Yutao Guo

Jeff S. Healey

Mellanie T. Hills

Linda Johnson

Gregory Y. H. Lip

Trudie Lobban

Peter W. Macfarlane

Gregory M. Marcus

David D. McManus

Jessica Orchard

Marco V. Perez

Renate B. Schnabel

Breda Smyth

Steven Steinhubl

Mintu P. Turakhia



Abstract

The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional–led randomized controlled studies using multiple ECG recordings or continuous ECG monitoring to detect AF have failed to demonstrate a significant reduction in stroke. Although it remains uncertain if consumer-led AF screening reduces stroke, it could increase early diagnosis of AF and facilitate an integrated approach, including appropriate anticoagulation, rate or rhythm management, and risk factor modification to reduce complications. Companies marketing AF screening devices should report the accuracy and performance of their products in high- and low-risk populations and avoid claims about clinical outcomes unless improvement is demonstrated in randomized clinical trials. Generally, the diagnostic yield of AF screening increases with the number, duration, and temporal dispersion of screening sessions, but the prognostic importance may be less than for AF detected by single–time point screening, which is largely permanent, persistent, or high-burden paroxysmal AF. Consumer-initiated ECG recordings suggesting possible AF always require confirmation by a health care professional experienced in ECG reading, whereas suspicion of AF on the basis of photoplethysmography must be confirmed with an ECG. Consumer-led AF screening is unlikely to be cost-effective for stroke prevention in the predominantly young, early adopters of this technology. Studies in older people at higher stroke risk are required to demonstrate both effectiveness and cost-effectiveness. The direct interaction between companies and consumers creates new regulatory gaps in relation to data privacy and the registration of consumer apps and devices. Although several barriers for optimal use of consumer-led screening exist, results of large, ongoing trials, powered to detect clinical outcomes, are required before health care professionals should support widespread adoption of consumer-led AF screening.

Journal Article Type Review
Acceptance Date Aug 22, 2022
Online Publication Date Nov 7, 2022
Publication Date 2022
Deposit Date Dec 1, 2022
Journal Circulation
Print ISSN 0009-7322
Electronic ISSN 1524-4539
Publisher American Heart Association
Peer Reviewed Peer Reviewed
Volume 146
Issue 19
Pages 1461-1474
DOI https://doi.org/10.1161/circulationaha.121.058911
Public URL http://researchrepository.napier.ac.uk/Output/2967691