Q&A: May an Apple Watch change the ‘one-size-fits-all’ strategy to AFib?
Late final month, Northwestern College and Johns Hopkins College introduced they’d acquired about $37 million from the Nationwide Coronary heart, Lung and Blood Institute to check a brand new strategy to stroke prevention in sufferers with atrial fibrillation, an irregular coronary heart rhythm.
The funds will help the Rhythm Analysis for AntiCoagulaTion (REACT-AF) trial, a seven-year examine that can present some sufferers with an Apple Watch to watch for AFib. They will have the ability to take blood thinners in response to a protracted episode, whereas sufferers within the management group will obtain the present customary of care, repeatedly taking the drug to scale back stroke threat.
Dr. Rod Passman, director of the Middle for Arrhythmia Analysis at Northwestern’s Feinberg College of Drugs and principal investigator of the examine, sat down with MobiHealthNews to elucidate the upcoming analysis and the way client gadgets might enhance affected person care.
MobiHealthNews: Are you able to clarify the examine design and what you are hoping to study from this analysis?
Dr. Rod Passman: We’re trying on the main downside of the most typical irregular coronary heart rhythm, which is atrial fibrillation. We all know that individuals with atrial fibrillation, significantly these with different cardiovascular threat elements like hypertension, are at a considerably elevated threat of stroke.
The present strategy is to take a blood thinner. If you happen to apply the standards for being on a blood thinner to the U.S. inhabitants with atrial fibrillation, possibly 80-plus % of sufferers who’ve atrial fibrillation could be on these anticoagulants for the remainder of their lives. We kind of have a one-size-fits-all strategy. We deal with people who find themselves repeatedly within the irregular rhythm with the identical day by day blood thinner as we do the person who has one episode a yr, or who has no additional episodes as a result of they’ve had an ablation accomplished, or they’re on a drug, or they’ve misplaced weight, or they’ve stopped ingesting alcohol.
So, I believe this one-size-fits-all strategy would not make a whole lot of sense in an period the place we will monitor folks to see whether or not they’re actually having episodes. So, the aim right here was to guage a paradigm shift, proper? As a substitute of people in danger, can we take a look at intervals of threat? Can we deal with at-risk sufferers with a focused strategy to being on a blood thinner, the place they take it just for a couple of weeks and solely in response to a multi-hour episode of atrial fibrillation?
MHN: If this methodology of steady monitoring is validated by the examine, how do you suppose this may enhance upon the present customary of care?
Passman: From our estimates, this strategy could apply to possibly half the inhabitants with atrial fibrillation. And what this implies is that we will cut back the publicity to those medicines, that are very efficient at lowering stroke threat however are additionally contributors to each main and minor bleeding.
So, if we will defend folks in opposition to stroke and decrease the publicity to the dangers of the blood thinners, then we will enhance the lives of our sufferers. And this has different implications, proper? Not solely would this be protecting in opposition to stroke and cut back bleeding threat, however this may additionally, we imagine, enhance their high quality of life as a result of many sufferers curtail their actions. They might not go mountain biking or snowboarding due to the dangers of trauma.
We additionally imagine that this may be a value financial savings to the healthcare system as a result of these blood thinners might be expensive and the price of bleeding on these blood thinners is a serious expense. So, if you should purchase a tool at your native electronics retailer for a fraction of the fee, this might not solely enhance high quality of life, however accomplish that at a decrease price.
MHN: Why did you select to make use of a client machine, the Apple Watch, for the examine, versus a scientific monitoring system?
Passman: We did two pilot research, one utilizing implantable cardiac screens, and one utilizing pacemakers and defibrillators. These gadgets are very correct in detecting atrial fibrillation. The issue is, the price of utilizing an implantable monitor for this indication just isn’t scalable to the tens of tens of millions of individuals around the globe who could profit from this strategy.
Extra importantly, these gadgets aren’t patient-facing, they’re physician-facing. As your physician, I’ll get the information out of your implantable monitor, and I’ll get it a day later. A client electronics machine is way more scalable, and the affected person will get alerted once they have an episode.
These points permit us to in the end make this point-of-care. This can be like a diabetic who checks their blood sugar, is aware of how a lot insulin to absorb response to a selected stage and might do this process with out ever having to name their physician. If it is a optimistic examine, we hope that stroke prevention and atrial fibrillation comply with an analogous path.
MHN: You’ve got accomplished different analysis and written about wearables and digital well being know-how for such a monitoring. What do you suppose are among the obstacles to utilizing these sorts of instruments extra broadly throughout the healthcare system?
Passman: From a affected person perspective, there are nonetheless prices concerned that will create boundaries for some people. I do suppose that the healthcare system just isn’t essentially well-equipped to take care of the deluge of knowledge which may be coming from these wearable gadgets that we could also be requested to evaluate.
And I believe in lots of circumstances, the know-how is on the market, however the pivotal trials displaying that the usage of this know-how improves lives remains to be missing. So, we imagine that this examine is a serious step in critically evaluating a consumer-grade electronics machine to indicate how we will leverage this know-how that you could purchase at Finest Purchase to save lots of your life, cut back price, and enhance each how lengthy you reside and the way nicely you reside.
MHN: Some digital well being applied sciences have scientific proof behind them, however a whole lot of them don’t. From a clinician’s perspective, does that make it tough to advocate these instruments to sufferers?
Passman: Within the case of Apple, they and lots of corporations have gone by rigorous analysis of the know-how to evaluate the accuracy. So, in lots of circumstances, these gadgets do carry out in the best way that we would like them to. The Apple Coronary heart Examine and the Fitbit examine are huge trials that I believe did a very good job of evaluating can these gadgets do what they’re presupposed to be doing.
However how we combine this into care, and the way we show that giving sufferers these highly effective instruments impacts their journey by the healthcare system, these sorts of research are missing. I believe that, in lots of circumstances, this know-how has appeared sooner than our potential to determine easy methods to combine this into care.
The instance I give is, within the conventional healthcare system, a physician orders checks after which we get the outcomes and we talk about with the affected person. Digital well being permits sufferers to offer us the outcomes of a check that we did not order. And we have to show, as I believe that we’ll, that that enables us to diagnose illness earlier to maintain folks at dwelling and to handle their illness remotely.
However that can problem the standard healthcare system, the place folks come to an workplace appointment once they’re feeling nicely or an emergency division once they’re feeling poorly. We have to create the methods that permit us to take this data and handle sufferers remotely, and guarantee that we’re permitting this know-how to maintain sufferers away from the healthcare system.