AF management using a diagnostic smartphone application: in-hospital validation and remote monitoring study

Oral presentation Belgian Heart Rhythm Meeting 

October 8th 2015

Objectives:

The recurrence of Atrial Fibrillation (AF) after electrical cardioversion occurs in almost 50% of the cases, especially during the first weeks1. This work focuses on the development and clinical validation of a smartphone application for the follow-up and management of patients post- AF treatment in a home environment.

Methods:

In this work we developed and clinically validated a smartphone application to determine irregular heart rhythms based on the photopletysmographic signal derived by the finger of the user and the smartphone camera. The application was validated in an in-hospital setting on patients eligible for cardioversion. Recordings were compared versus ECG interpretations. Next, a subset of these patients were randomized in a remote monitoring study. This study consists of a remote monitoring arm (RM) with the smartphone application and the usual care arm (UC). The primary endpoint is the early detection of AF recurrence.

Results:

The in-hospital validation study included 121 consecutive subjects with a mean age of 66±12 years. 36% was in the possession of a smartphone and 90% of the patients underwent cardioversion. Sensitivity and specificity analysis indicated an accuracy of 97.2% in the identification of AF. The home monitoring study is ongoing with currently 13 subjects from which 6 in the RM arm. Overall, average time of study participation was 31 days where the RM group performed 564 measurements. High compliance, engagement and motivation was found in the RM group. From the 6 included RM patients, 2 subjects had a recurrence of AF prior to their scheduled follow-up visit, and therapy was adjusted accordingly. In the UC group 3 patients were diagnosed with a recurrence of AF that was only detected at first follow-up consultation.

Conclusion:

The obtained results indicate that a smartphone application can serve as an accurate sensor in the detection of irregular heart rhythms, and more specifically, in the detection of atrial fibrillation. Additionally the use of a smartphone in a post-AF treatment setting enables faster detection of AF recurrence and adjustment of treatment strategies.