Atrial fibrillation, often called AFib or AF, is a commonly treated type of heart arrhythmia that causes issues with blood flow. While some people who have AFib might experience symptoms such as irregular heartbeat or chest pain, it can also be asymptomatic or paroxysmal and require tracking for diagnosis. Undiagnosed AFib can lead to additional health complications such as an increase in the risk of stroke or heart failure.
There are common tests to diagnose AFib such as Electrocardiograms (ECG or EKG), blood tests, or stress tests. These tests need to be performed under medical supervision and uninsured patients can expect to pay up to $3,000. Even with insurance, multiple tests can begin to compound quickly. In several recent studies, researchers found that wearable devices used for screening AFib may be more cost-effective than other techniques that are currently popular.
Traditional vs. Modern
The reliability of popular ECG tests, such as a Holter monitor, can be affected by how bulky or awkward the devices used are. The Holter monitor requires wires and electrodes to be placed on the chest and a small device to be hung around the patient’s neck for 24 hours. This can cause a change of behavior and skew the results.
Fitness trackers and smartwatches are smaller and lighter, and blend easily into a patient’s life, allowing for better accuracy in tracking. Wearable ECG devices use photoplethysmography (PPG) embedded and were found to have reliability ranging from 79% to 99% according to a report by The Korea Society of Medical Informatics. In the Huawei Heart Study, the positive predictive value of PPG signals was 91.6%.
In a study published in the JAMA Health Forum on 30 million simulated people with profiles matching the age, sex, and comorbidity of the U.S. population aged 65 or older, the use of wrist-worn wearables equipped with PPG proved to be a cost-effective solution. The incremental cost-effectiveness ratio, defined as U.S. dollars per quality-adjusted life-year (QALY), was determined to be $57,894 per QALY, below the acceptability threshold of $100,000.
Comparing eight screening strategies – six with wrist-worn wearable devices and two using traditional modalities (pulse palpitation and ECG) – against no screening, it was found that all six of the wrist wearables were more effective even over the traditional methods. This cost-effectiveness was also found in scenarios where the minimum age was lowered as far down as 50. For this age group, the cost per QALY was found to be $90,909, still lower under the $100,000 threshold.
While the findings from a wearable device can’t diagnose AFib, it can help patients to track their symptoms and capture biometrics, especially during prolonged periods, including sleep. “This essentially means that, in this strategy, the device is doing the initial screening for atrial fibrillation on the user in the background,” said Steven A. Lubitz, MD, MPH, senior author of the JAMA Health cost-effectiveness investigation. These devices, combined with healthcare apps such as Cardiogram, could provide valuable data for healthcare providers to provide an accurate diagnosis and help individuals to advocate for their heart health.
“Atrial Fibrillation.” Centers for Disease Control and Prevention, 12 Jul. 2022, www.cdc.gov/heartdisease/atrial_fibrillation.htm.
“Consumer wearable technology advancements may support AFib detection.” Bristol Myers Squibb, 15 Apr. 2022, www.bms.com/life-and-science/news-and-perspectives/wearable-technology-advancements-for-afib-detection.html.
Biscaldi, Lauren. “Promises and Pitfalls of Wearable Devices for Atrial Fibrillation Detection Evaluated.” Clinical Advisor, 2 Jul. 2021, www.clinicaladvisor.com/home/meeting-coverage/aanp-2021/pitfalls-promises-wearable-devices-atrial-fibrillation-detection-evaluated/.
Chen, Wanyi PhD, et al. “Cost-effectiveness of Screening for Atrial Fibrillation Using Wearable Devices.” JAMA Network, 5 Aug. 2022, www.jamanetwork.com/journals/jama-health-forum/fullarticle/2794835.
Cox, Caitlin. “Wearable Devices Are Cost-effective AF Screening Tools.” tctmd, 10 Aug. 2022, www.tctmd.com/news/wearable-devices-are-cost-effective-af-screening-tools.
El-Amrawy, Fatema B.Pharm, and Nounou, Mohamed Ismail PhD. “Are Currently Available Wearable Devices for Activity Tracking and Heart Rate Monitoring Accurate, Precise, and Medically Beneficial?” Synapse, 31 Oct. 2015, www.synapse.koreamed.org/articles/1075768.
Vijayan, V., Connolly, J. P., Condell, J., McKelvey, N., & Gardiner, P. (2021). Review of Wearable Devices and Data Collection Considerations for Connected Health. Sensors (Basel, Switzerland), 21(16). https://doi.org/10.3390/s21165589