DIGITAL-AF II Trial shows that mass screenings for atrial fibrillation are feasible

By Mellanie True Hills and Melissa Moss

May 11, 2019

  • Summary: DIGITAL-AF II Trial shows the feasibility of mass atrial fibrillation screenings using a smartphone app without consuming extensive healthcare resources
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There are many people walking around who don’t know that they have atrial fibrillation, which may put them at risk for a stroke. Opportunistic screening is commonly recommended, especially for those age 65 and older, but doing so is time-consuming and taxes healthcare resources.

During the Late-Breaking Clinical Trials at Heart Rhythm 2019 in San Francisco, results of the Digital-AF II study were presented by investigator Tine Proesmans from Hasselt University in Belgium. This was a novel approach to initiating mass afib screening.

The study incorporated a smartphone app where you place your finger over the phone’s camera to measure heart rhythm. This is called pulse-plethysmography (PPG).

The study took place in Belgium during two weeks in December of 2018. A newspaper ad and other communications to raise awareness and educate about afib featured a QR-code that allowed people to access the FibriCheck app on their smartphones in order to take part in the study.

Participants were asked to measure their heart rhythm with the app twice each day for eight days, and could also measure if they felt symptoms. They recorded their symptoms, and the app categorized their heart rhythm as regular, possible afib, irregular rhythm, or unknown due to quality issues. All irregular measurements were analyzed by medical personnel, and those participants received a report with a conclusion and copies of their rhythm traces that they could use to consult with their doctors.

During the two weeks, more than 60,000 people checked their heart rhythm, and 791 participants (1.3%) were found to have possible afib. Of that 791, 72% had no symptoms of afib.

Those with persistent afib are typically found upon the first measurement; in this study, all 210 patients (27%) with persistent AF were detected on the first measurement.

Those with paroxysmal afib often must be measured for several days before afib is detected, so the eight-day monitoring period greatly increased the yield of those with paroxysmal afib. While 111 with paroxysmal afib were detected on the first measurement, a total of 581 (73%) were eventually found over eight days to have paroxysmal afib.

The prevalence of afib in this population was 1.68% in those age 40-49, 2.16% in age 50-59, 3.23% in age 60-69, 5.97% in age 70-79, and 12.3% in age 80+.

This study was novel in that it did not consume healthcare resources to conduct the screenings as people self-monitored using the smartphone app. It showed the feasibility of such mass screenings and also raised awareness of atrial fibrillation in the general population.

The next phase will involve questionnaires for those who were shown to have indications of afib and to understand their decision-making process and follow up with doctors. Future trials are expected to continue screenings beyond Belgium.