Author + information
- Received July 28, 2019
- Revision received August 10, 2019
- Accepted August 19, 2019
- Published online September 1, 2019.
- Yutao Guo, M.D., Ph.D.1,
- Hao Wang, M.D., Ph.D.1,
- Hui Zhang, M.D.1,
- Tong Liu, M.D., Ph.D.3,
- Zhaoguang Liang, M.D., Ph.D.4,
- Yunlong Xia, M.D., Ph.D.5,
- Li Yan, M.D., Ph.D.6,
- Yunli Xing, M.D., Ph.D.7,
- Haili Shi, M.D.8,
- Shuyan Li, M.D., Ph.D.9,
- Yanxia Liu, M.D.10,
- Fan Liu, M.D.11,
- Mei Feng, M.D.12,
- Yundai Chen, M.D., Ph.D.1,∗ (, )
- Gregory Y.H. Lip, M.D., Ph.D.2,∗∗ (, )
- On behalf of the MAFA II investigators
- 1Institutional Affiliations a Chinese PLA General Hospital, Beijing, China
- 2Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, United Kingdom, and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- 3Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- 4The First Affiliated Hospital of Haerbing Medical University, Haerbing, China
- 5The First Affiliated Hospital of Dalian Medical University, Dalian, China
- 6Yunnan Cardiovascular Hospital, Kunmin, China
- 7Beijing Friendship Hospital, Capital Medical University, Beijing, China
- 8Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
- 9The First Hospital of Jilin University, Changchun, Jilin, China
- 10General Hospital of Shenyang Military, Shenyang, China
- 11The Second Hospital of Hebei Medical University, Shijiazhuang, China
- 12Shanxi Da hospital, Taiyuan, China
- ↵∗Corresponding Authors: Yundai Chen, MD, PhD Chinese PLA General Hospital Department of Cardiology No.28, Fuxin Road Beijing, 100853 China Telephone: + 8618610530521 Fax:0086-55499311.
- ↵∗∗Gregory YH Lip, MD, PhD, Liverpool Centre for Cardiovascular Science, William Henry Duncan Building West Derby Street Liverpool, Merseyside L7 8TX United Kingdom Telephone: 0151-794-9020.
Background Low detection and nonadherence are major problems in current management approaches for patients with suspected atrial fibrillation (AF). Mobile health (mHealth) devices may enable earlier AF detection, and improved AF management.
Objectives To investigate the effectiveness of AF screening in a large population-based cohort using smart device based photoplethysmography (PPG) technology, combined with a clinical care AF management pathway using a mHealth approach.
Methods AF screening was performed with smart devices using PPG technology (Huawei Technologies Co., Ltd., Shenzhen, China) which were made available for the population aged over 18 years across China. Monitoring for at least 14-days with a wristband (HONOR BAND 4) or wristwatch (HUAWEI WATCH GT, HONOR WATCH), was allowed. The patients with ‘possible AF’ episodes using the PPG algorithm were further confirmed by health providers among the MAFA (mobile AF App) Telecare center and network hospitals, with clinical evaluation, electrocardiogram (ECG), or 24-h Holter.
Results There were 246,541 individuals who downloaded the PPG screening App, and 187,912 individuals used smart devices to monitor their pulse rhythm between October 26, 2018 and May 20, 2019. Among those with PPG monitoring (mean age 35 years, 86.7% male), 424 (mean age 54 years, 87.0% male) received a ‘suspected AF’ notification (424/187,912, 0.23%). Of those effectively followed up, 227 individuals (227/262, 87.0%) were confirmed as having AF, with the positive predictive value (PPV) of PPG signals being 91.6% (95% confidential interval (CI) 91.5%-91.8%). Both ‘suspected AF’ and ‘identified AF’ markedly increased with age (p for trend <0.001), and individuals in Northeast China had the highest proportion of detected AF of 0.28% (95%CI 0.20-0.39). Of the individuals with identified AF, 216 (216/227, 95.1%) subsequently entered a programme of integrated AF management using a mobile AF application (mAFA); approximately 80% of ‘high risk’ patients were successfully anticoagulated.
Conclusions Based on the present study, continuous home-monitoring with smart device based PPG technology could be a feasible approach for AF screening. This would help efforts at screening and detection of AF, as well as early interventions to reduce stroke and other AF-related complications.
- Received July 28, 2019.
- Revision received August 10, 2019.
- Accepted August 19, 2019.
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