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 assist the Rhythm Analysis for AntiCoagulaTion (REACT-AF) trial, a seven-year examine that may present some sufferers with an Apple Watch to watch for AFib. They will be capable of take blood thinners in response to a chronic episode, whereas sufferers within the management group will obtain the present normal of care, constantly taking the drug to cut back stroke danger.
Dr. Rod Passman, director of the Heart 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 units may enhance affected person care.
MobiHealthNews: Are you able to clarify the examine design and what you are hoping to be taught from this analysis?
Dr. Rod Passman: We’re trying on the main drawback of the most typical irregular coronary heart rhythm, which is atrial fibrillation. We all know that individuals with atrial fibrillation, notably these with different cardiovascular danger elements like hypertension, are at a considerably elevated danger of stroke.
The present strategy is to take a blood thinner. For those who apply the factors for being on a blood thinner to the U.S. inhabitants with atrial fibrillation, possibly 80-plus p.c of sufferers who’ve atrial fibrillation could be on these anticoagulants for the remainder of their lives. We form of have a one-size-fits-all strategy. We deal with people who find themselves constantly within the irregular rhythm with the identical every day blood thinner as we do the person who has one episode a 12 months, or who has no additional episodes as a result of they’ve had an ablation carried out, or they’re on a drug, or they’ve misplaced weight, or they’ve stopped consuming alcohol.
So, I believe this one-size-fits-all strategy does not make plenty of sense in an period the place we will monitor individuals to see whether or not they’re actually having episodes. So, the purpose right here was to guage a paradigm shift, proper? As an alternative of people in danger, can we take a look at intervals of danger? Can we deal with at-risk sufferers with a focused strategy to being on a blood thinner, the place they take it just for just a few 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 assume this may enhance upon the present normal of care?
Passman: From our estimates, this strategy might apply to possibly half the inhabitants with atrial fibrillation. And what this implies is that we will scale back the publicity to those drugs, that are very efficient at lowering stroke danger however are additionally contributors to each main and minor bleeding.
So, if we will shield individuals towards 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 towards stroke and scale back bleeding danger, 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 price financial savings to the healthcare system as a result of these blood thinners could be pricey 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 price, 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 gadget, 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 units are very correct in detecting atrial fibrillation. The issue is, the price of utilizing an implantable monitor for this indication is just not scalable to the tens of tens of millions of individuals around the globe who might profit from this strategy.
Extra importantly, these units usually are not patient-facing, they’re physician-facing. As your physician, I’ll get the info out of your implantable monitor, and I’ll get it a day later. A client electronics gadget is way more scalable, and the affected person will get alerted once they have an episode.
These points permit us to finally make this point-of-care. This might be like a diabetic who checks their blood sugar, is aware of how a lot insulin to absorb response to a specific stage and may try this process with out ever having to name their physician. If this can be a optimistic examine, we hope that stroke prevention and atrial fibrillation comply with an analogous path.
MHN: You’ve got carried out different analysis and written about wearables and digital well being know-how for such a monitoring. What do you assume are a few of the obstacles to utilizing these sorts of instruments extra broadly inside the healthcare system?
Passman: From a affected person perspective, there are nonetheless prices concerned which will create limitations for some people. I do assume that the healthcare system is just not essentially well-equipped to take care of the deluge of information which may be coming from these wearable units that we could also be requested to evaluate.
And I believe in lots of instances, the know-how is on the market, however the pivotal trials displaying that using this know-how improves lives continues to be missing. So, we imagine that this examine is a serious step in critically evaluating a consumer-grade electronics gadget to point out how we will leverage this know-how you can purchase at Greatest Purchase to avoid wasting your life, scale back price, and enhance each how lengthy you reside and the way effectively you reside.
MHN: Some digital well being applied sciences have scientific proof behind them, however plenty of them don’t. From a clinician’s perspective, does that make it tough to suggest these instruments to sufferers?
Passman: Within the case of Apple, they and plenty of firms have gone by way of rigorous analysis of the know-how to evaluate the accuracy. So, in lots of instances, these units do carry out in the best way that we would like them to. The Apple Coronary heart Examine and the Fitbit examine are large trials that I believe did a very good job of evaluating can these units do what they’re purported 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 way of the healthcare system, these sorts of research are missing. I believe that, in lots of instances, this know-how has appeared sooner than our potential to determine how one can combine this into care.
The instance I give is, within the conventional healthcare system, a health care provider orders exams after which we get the outcomes and we focus on with the affected person. Digital well being permits sufferers to present us the outcomes of a take a look at that we did not order. And we have to show, as I believe that we’ll, that that permits us to diagnose illness earlier to maintain individuals at dwelling and to handle their illness remotely.
However that may problem the standard healthcare system, the place individuals come to an workplace appointment once they’re feeling effectively or an emergency division once they’re feeling poorly. We have to create the programs that permit us to take this info and handle sufferers remotely, and make it possible for we’re permitting this know-how to maintain sufferers away from the healthcare system.