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 research that can present some sufferers with an Apple Watch to watch for AFib. They will be capable to take blood thinners in response to a protracted 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 Faculty of Drugs and principal investigator of the research, sat down with MobiHealthNews to elucidate the upcoming analysis and the way client units might enhance affected person care.
MobiHealthNews: Are you able to clarify the research design and what you are hoping to be taught from this analysis?
Dr. Rod Passman: We’re wanting 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 danger components like hypertension, are at a considerably elevated danger of stroke.
The present strategy is to take a blood thinner. In case you apply the standards 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 each 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 finished, or they’re on a drug, or they’ve misplaced weight, or they’ve stopped ingesting alcohol.
So, I feel 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 really having episodes. So, the objective right here was to guage a paradigm shift, proper? As a substitute of people in danger, can we have a look at durations 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 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 research, how do you suppose this could enhance upon the present normal 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 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 defend individuals 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 scale back bleeding danger, however this could additionally, we imagine, enhance their high quality of life as a result of many sufferers curtail their actions. They could not go mountain biking or snowboarding due to the dangers of trauma.
We additionally imagine that this could be a price financial savings to the healthcare system as a result of these blood thinners could be expensive and the price of bleeding on these blood thinners is a significant expense. So, if you should buy 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 value.
MHN: Why did you select to make use of a client system, the Apple Watch, for the research, versus a scientific monitoring system?
Passman: We did two pilot research, one utilizing implantable cardiac displays, 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 hundreds of thousands of individuals around the globe who could profit from this strategy.
Extra importantly, these units will not be 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 system is way more scalable, and the affected person will get alerted after they have an episode.
These points enable us to finally make this point-of-care. This can be like a diabetic who checks their blood sugar, is aware of how a lot insulin to soak up response to a selected stage and might do this job with out ever having to name their physician. If it is a constructive research, we hope that stroke prevention and atrial fibrillation observe an identical path.
MHN: You’ve got finished different analysis and written about wearables and digital well being know-how for such a monitoring. What do you suppose are a number 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 obstacles for some people. I do suppose that the healthcare system is just not essentially well-equipped to take care of the deluge of knowledge that could be coming from these wearable units that we could also be requested to evaluate.
And I feel in lots of instances, the know-how is on the market, however the pivotal trials exhibiting that the usage of this know-how improves lives continues to be missing. So, we imagine that this research is a significant step in critically evaluating a consumer-grade electronics system to point out how we will leverage this know-how which you can purchase at Greatest Purchase to avoid wasting your life, scale back value, 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 advocate these instruments to sufferers?
Passman: Within the case of Apple, they and lots of firms have gone by means 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 wish them to. The Apple Coronary heart Research and the Fitbit research are large trials that I feel did a very good job of evaluating can these units do what they’re alleged 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 means of the healthcare system, these sorts of research are missing. I feel that, in lots of instances, this know-how has appeared sooner than our means to determine find out how to combine this into care.
The instance I give is, within the conventional healthcare system, a physician orders exams after which we get the outcomes and we focus on with the affected person. Digital well being permits sufferers to provide 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 house and to handle their illness remotely.
However that can problem the standard healthcare system, the place individuals come to an workplace appointment after they’re feeling effectively or an emergency division after they’re feeling poorly. We have to create the programs that enable us to take this data and handle sufferers remotely, and make it possible for we’re permitting this know-how to maintain sufferers away from the healthcare system.