Q&A: Might an Apple Watch change the ‘one-size-fits-all’ strategy to AFib?
Late final month, Northwestern College and Johns Hopkins College introduced they’d obtained 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’re going to be capable of take blood thinners in response to a chronic episode, whereas sufferers within the management group will obtain the present customary of care, repeatedly taking the drug to cut back stroke threat.
Dr. Rod Passman, director of the Heart for Arrhythmia Analysis at Northwestern’s Feinberg Faculty of Medication and principal investigator of the research, sat down with MobiHealthNews to clarify the upcoming analysis and the way shopper 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 folks 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 p.c of sufferers who’ve atrial fibrillation can be on these anticoagulants for the remainder of their lives. We type of have a one-size-fits-all strategy. We deal with people who find themselves repeatedly 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 accomplished, or they’re on a drug, or they’ve misplaced weight, or they’ve stopped consuming alcohol.
So, I feel this one-size-fits-all strategy does not make plenty of sense in an period the place we are able to monitor individuals to see whether or not they’re really having episodes. So, the purpose right here was to guage a paradigm shift, proper? As an alternative of people in danger, can we have a look at durations 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 research, how do you assume this is able to 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 are able to scale back the publicity to those medicines, that are very efficient at decreasing stroke threat however are additionally contributors to each main and minor bleeding.
So, if we are able to defend individuals towards stroke and decrease the publicity to the dangers of the blood thinners, then we are able to enhance the lives of our sufferers. And this has different implications, proper? Not solely would this be protecting towards stroke and scale back bleeding threat, however this is able to additionally, we consider, 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 consider that this is able to be a price 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 significant 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 shopper gadget, 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 tens of millions of individuals around the globe who could profit from this strategy.
Extra importantly, these units aren’t 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 shopper electronics gadget is way more scalable, and the affected person will get alerted after they have an episode.
These points permit us to finally make this point-of-care. This shall be like a diabetic who checks their blood sugar, is aware of how a lot insulin to soak up response to a specific degree and may try this activity with out ever having to name their physician. If this can be a optimistic research, we hope that stroke prevention and atrial fibrillation observe the same path.
MHN: You’ve got accomplished different analysis and written about wearables and digital well being expertise for this kind of monitoring. What do you assume 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 assume that the healthcare system is just not essentially well-equipped to cope with the deluge of information that could be coming from these wearable units that we could also be requested to evaluate.
And I feel in lots of circumstances, the expertise is on the market, however the pivotal trials exhibiting that using this expertise improves lives remains to be missing. So, we consider that this research is a significant step in critically evaluating a consumer-grade electronics gadget to indicate how we are able to leverage this expertise that you would be able to purchase at Finest 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 troublesome 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 expertise to evaluate the accuracy. So, in lots of circumstances, these units do carry out in the best way that we would like them to. The Apple Coronary heart Research and the Fitbit research are huge trials that I feel did a extremely good job of evaluating can these units 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 way of the healthcare system, these sorts of research are missing. I feel that, in lots of circumstances, this expertise has appeared quicker than our capacity to determine the best way 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 take a look at that we did not order. And we have to show, as I think that we are going to, that that enables us to diagnose illness earlier to maintain individuals at dwelling 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 techniques that permit us to take this info and handle sufferers remotely, and guarantee that we’re permitting this expertise to maintain sufferers away from the healthcare system.