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A pulse check in at-risk patients, as part of a patient assessment, can be a critical first step toward diagnosing and managing AFib.1,2
Pulse checks can help detect potential irregular heart rhythms such as AFib. If AFib is suspected, additional monitoring or tests to make a diagnosis should be conducted.2
Detecting AFib in Your Patients
Dr. Ami Bhatt presents a hypothetical patient case and the approach to the detection and diagnosis of her condition
AFib assessment options via telehealth
The methods for assessing a patient for AFib aren’t new but the means of collecting cardiac health information continue to evolve as new technologies become available.3
The increased use of telehealth may require clinicians to obtain patient information in new ways, starting with the pulse check.2 Some patients and caregivers can be trained to take the pulse at the wrist. If any irregularities are observed, they should be reported to the healthcare provider as this can be a clue for a potential arrhythmia, such as AFib.
Click here to find considerations when using telehealth for remote physical exams,
including remote pulse checks and heart-related tips.
If a patient mentions symptoms or reports an irregular rhythm during a telehealth
visit, it’s important to schedule an in-person visit for further evaluation. At this
time, a 12-lead ECG test, echocardiogram, or other diagnostic procedure
may be necessary.
Whether in-office or through a telehealth visit, the pulse
check remains a critical first step to detecting AFib.
Patient use of health-related technology
There has been a shift in how patients use technology to gather health information. Patients continue to use telehealth with HCPs, and many have turned to other forms of technology to help monitor their cardiac health beyond an in-office visit.2,4
Monitoring for AFib beyond the office
Evolving technology, such as patient-facing mobile devices, are being used for the monitoring of cardiac health.4
These devices, such as wearables, can be useful assessment tools for remote patient monitoring.5 These devices can be used to monitor at-risk patients or those who require observation outside of office visits.3 These devices may also help you detect previously unidentified AFib, particularly in asymptomatic patients or those experiencing paroxysmal AFib who may not be aware of the condition or the associated risk of stroke.3
Assessing for AFib in At-risk Patients
Dr. Ami Bhatt discusses various options that are available to detect AFib in at-risk patients
The FDA has cleared a number of devices to monitor heart rate and rhythm that could be used to help assess patients remotely.3,5
Remote patient monitoring with wearable technology offers 2 different methods for analyzing heart rate and rhythm
–photoplethysmograph (PPG) and electrocardiograph (ECG), both of which can aid in the detection of AFib.6
| PPG | ECG |
Smartwatches and fitness bands equipped with PPG technology function much like a pulse oximeter, using light to detect changes in blood volume in the tissue. This technology can be used to detect rhythms through continuous pulse monitoring, alerting patients of any irregular heart rhythm.4 |
Some wearables and handheld devices use either a single-lead or multi-lead ECG for intermittent monitoring, providing irregular rhythm alerts and a rhythm strip output.6 |
There are important considerations and potential limitations associated with different methods of AFib detection that must be independently evaluated by HCPs. Bristol Myers Squibb and Pfizer do not recommend any specific screening device or methodology. Methods/devices provided are for informational purposes only.
Fitbit® is a registered trademark of Google LLC. Omron® is a registered trademark of Omron Corporation. AliveCor® and KardiaMobile® are registered trademarks of AliveCor, Inc. Apple Watch® is a registered trademark of Apple, Inc. PREVENTICE® is a registered trademark of Preventice Solutions Inc. QARDIOCORE® is a registered trademark of Qardio, Inc. iRhythm® and Zio® are registered trademarks of iRhythm Technologies, Inc. MEDTRONIC® and REVEAL LINQ® are registered trademarks of Medtronic, Inc.
These devices went through a regulatory/clearance process and were deemed appropriate for marketed use.8 The clearance of several mobile and digital technologies for heart rhythm monitoring has introduced various options for consumer-driven arrhythmia detection and care.6,9
Patients are using technology to engage in their own care
In one online survey by The Harris Poll in 2019 of more than 2000 adults, people adopted wearables for overall health monitoring at a rate of nearly 65%, with heart rate monitoring being used at a rate of 32%5*
In a separate survey conducted by Accenture in 2020 of 2700 patients across a number of disease states, 60% reported they wanted to use technology more in the future to monitor and manage their conditions10†
A 2019 online survey by The Harris Poll of more than 2000 adults to measure usage and sentiments toward telehealth, and weighted to be representative of the general American adult population across standard demographics. This survey was commissioned by American Well (Amwell), a telemedicine company.
A survey conducted by Accenture of 2700 cardiology, immunology, and oncology patients in the US, UK, France, Germany, China, and Japan who have been going to healthcare facilities for treatment or treating at home.
As technology evolves, various FDA-cleared devices can be
used to remotely monitor at-risk patients for AFib.
How could remote monitoring help improve AFib in at-risk patients?
Whether symptomatic or asymptomatic, remote monitoring may be a helpful tool in detecting AFib. Alerts from these devices help drive patients to their HCP with useful heart rhythm data, which may lead to important conversations about AFib and the related stroke risk.
A Cardiologist’s Perspectives on Remote Monitoring
Dr. Ami Bhatt talks about remote monitoring and shares her experience with one patient in particular
According to Dr. Ami Bhatt, it’s a good idea to consider factors such as your patient’s age, lifestyle, and comfort with various health-related technology when making decisions about monitoring for AFib. Shared decision making with patients is essential when individuals are using remote monitoring devices to monitor heart rate and rhythm at home.
When discussing use of remote monitoring devices, I instruct patients on how often to monitor to help prevent over-monitoring anxiety and stress the importance of sharing device alerts with our clinical team for medical evaluation.
Data from wearable devices may inform the need for an AFib work-up. Importantly, this can potentially lead to earlier detection of AFib. Sometimes, a 12-lead ECG may not capture AFib. However, clinicians may detect paroxysmal AFib through other medical-grade devices, such as wearable patch monitors. Early detection may be key to a timely diagnosis.
– Dr. Ami Bhatt, Cardiologist
Massachusetts General Hospital
Boston, Massachusetts
Dr. Bhatt was compensated for her time
Empowering patients to be part of their healthcare
Patient involvement in their health and the use of wearable devices generates data that can help identify irregular rhythms such as AFib in at-risk patients.3
Patients can become more involved in their healthcare
Patients can become advocates for their own care
Patients can share their device alerts and data with their physician and entire care team
Perspectives on Integrating Technology Into a Practice
Dr. Ami Bhatt shares her experience in integrating remote monitoring and data into her practice, as well as the benefits she sees for her patients
Potential benefits of remote monitoring for your at-risk patients
Better informed patient conversations
Remote monitoring may help detect and alert patients of an irregular heart rhythm, enabling informed patient conversations even with asymptomatic patients.
Real-time
monitoring
Wearables and mobile devices may allow for
Facilitate data-sharing across care teams
Remote monitoring may allow clinical data to be shared with multiple providers, which can facilitate communication and interdisciplinary care.3
Stay AFib vigilant. Monitor at-risk patients beyond the office with
FDA-cleared devices to help detect AFib and inform a timely diagnosis.
References:
- January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1-e76. doi:10.1016/j.jacc.2014.03.022
- Benziger CP, Huffman MD, Sweis RN, Stone NJ. The telehealth ten: a guide for a patient-assisted virtual physical examination. Am J Med. 2021;134(1):48-51. doi:10.1016/j.amjmed.2020.06.015
- Varma N, Marrouche NF, Aguinaga L, et al. HRS/EHRA/APHRS/LAHRS/ACC/AHA worldwide practice update for telehealth and arrhythmia monitoring during and after a pandemic. J Am Coll Cardiol. 2020;76(11):1363-1374.
- Faust O, Ciaccio EJ, Acharya UR. A review of atrial fibrillation detection methods as a service. Int J Environ Res Public Health. 2020;17(9):3093.
- American Well. Telehealth Index: 2019 Consumer Survey.
- Ding EY, Marcus GM, McManus DD. Emerging technologies for identifying atrial fibrillation. Circ Res. 2020;127:128-142.
- Pereira T, Tran N, Gadhoumi K, et al. Photoplethysmography based atrial fibrillation detection: a review. NPJ Digit Med. 2020;127:128-142.
- FDA Products and Medical Procedures. Updated September 14, 2021. https://www.fda.gov/medical-devices/products-and-medical-procedures
- Wan EY, Ghanbari H, Akoum N, et al. HRS white paper on clinical utilization of digital health technology. Cardiovasc Digit Health J. 2021;2(4):196-211. https://www.accenture.com/us-en/insights/lige-sciences/coronavirus-patient-behavior-research
- Accenture. COVID-19: Impact on Patient Behavior. https://www.accenture.com/us-en/insights/life-sciences/coronavirus-patient-behavior-research. Accessed July 25, 2022.
