New Research Suggests Potential of Digital Technologies in Improving Care Delivery

The use of digital technology to improve care delivery in patients with heart failure (HF) and atrial fibrillation (AFib) was the focus of a dedicated late-breaking science session during AHA 2021 featuring findings from the REVeAL-HF, Fitbit Heart and I-STOP-AFib studies.

In REVeAL-HF, mortality estimates provided to clinicians in alert form as they were entering an order did not lead to significant reductions in all-cause mortality or rehospitalization in patients hospitalized with acute HF.

Researchers randomized patients to either an alert when providers were entering an order or no alert and usual care. Data was collected via electronic health record. The composite outcome of all-cause mortality and rehospitalization was 38.9% among the alert group compared with 39.3% among the usual care group. Secondary outcomes were similar among the alert group and the usual care group, respectively, in terms of one-year mortality (27.1% vs. 26.9%), 30-day readmission (19.4% vs. 20.7%), and inpatient mortality (8.4% vs. 8.8%).

Additionally, mortality estimates did not significantly influence use of medical therapies, ICD implantation, HT/VAD, or referrals to palliative care, according to Tariq Ahmad, MD, MPH, FACC, who presented the findings on behalf of the investigators. He noted that "bedside clinicians may require more prescriptive decision support, as these results call into question the hypothesis that accurate prognostic information alone will lead to better clinical decision-making and improved outcomes" in this patient group.

In the Fitbit Heart study, a novel software algorithm compatible with a wide range of smartwatches and fitness trackers detected irregular heart rhythms and accurately identified undiagnosed AFib 98% of the time.

Investigators from Massachusetts General Hospital and Fitbit® remotely enrolled more than 455,000 adult smartwatch or fitness tracker users in the U.S. The median age of participants was 47 years, 71% were female and 73% were White. None of the study participants had a self-reported prior diagnosis of AFib. Participants who had an irregular heart rhythm detected by the software algorithm were notified and invited to schedule a visit with a telehealth professional. After meeting with the telehealth doctor, participants received a one-week electrocardiogram (ECG) patch monitor to wear along with the smartwatch or fitness tracker.

Overall findings found irregular heart rhythm detection occurred in 1% of individuals overall and 4% of adults older than 65 years. AFib was detected on the ECG patch monitor in 32% of those who received notification of an irregular heart rhythm. Additionally, the ECG patch confirmed AFib in 98% of individuals who had another irregular heart rhythm detection while wearing the patch. Researchers also noted that in individuals over the age of 65 years, the algorithm corresponded to concurrent AFib 97% of the time.

"These results show that wearables have the ability to identify undiagnosed AFib with high reliability," said Steven A. Lubitz, MD, MPH. The algorithm is currently being reviewed by the U.S. Food and Drug Administration for clearance and widespread use. The study did not test whether screening for AFib leads to a reduction in strokes, which Lubitz notes is an opportunity for future research.

In the I-STOP-AFib study, researchers found personalized testing may help identify triggers for irregular heart rhythms and reduce their frequency in AFib patients.

Researchers initially enrolled 446 participants in the trial, with 320 completing the study. They performed a remote, mobile application-based trial, and patients were randomly assigned to either monitor their AFib episodes without tracking their presumed triggers, or to test whether specific "triggers" affected or caused atrial fibrillation episodes. The comparison took place over a 10-week period, with both groups of patients using a specific device to monitor or track AFib triggers.

Overall findings found patients who completed the individualized trigger study reported less frequent episodes of AFib during the four weeks after their testing compared to those who only tracked AFib episodes. Additionally, alcohol consumption was associated with more AFib episodes than when patients avoided that trigger, while caffeine consumption was not linked to an increased risk of AFib episodes.

"There has been little research done on whether perceived triggers of AFib actually lead to AFib episodes," said Gregory Marcus, MD, MAS, FACC. "As this was the first study to tackle this idea, there are many lessons we have learned that future studies could build upon."

Keywords: AHA Annual Scientific Sessions, American Heart Association, AHA21, Heart Failure, Clinical Decision-Making, Arrhythmias, Cardiac, Atrial Fibrillation

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