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Smartphones for AF detection

Presented by
Prof. Axel Bauer, Innsbruck Medical University, Austria
ESC 2022
In the eBRAVE-AF trial, digital screening included a more than 2-fold detection rate of treatment-relevant atrial fibrillation (AF) over usual care. A certified App with photoplethysmography (PPG) via the smartphone camera was used for detection of abnormal PPGs, leading to ECG loop recordings for verification.

eBRAVE-AF (NCT04250220) compared digital, smartphone-based screening to detect treatment-relevant AF in comparison to normal care [1]. Eligible 67,488 policyholders of a big German health insurer were invited by mail; 5,551 invitees gave consent over the downloaded study app. There was no in-person contact with participants at any time. The primary endpoint was newly diagnosed AF with consequent start of oral anticoagulation.

In the first 6 months, 2,860 randomised participants performed PPG self-measurements over 1 minute twice daily in week 1 and 2, followed by twice weekly. The other participants received usual care. The data were used for analysing primary efficacy. From months 7–12, a cross-over took place. In case of abnormal PPG findings, the patients received an external ECG loop recorder for 2 weeks. Treatment decisions based on these recordings were solely done by a local physician independent from the study.

“The participants in our study were 66 years old, one third were women, and the median CHA2DS2-VASc score was 3,” Prof. Axel Bauer (Innsbruck Medical University, Austria) described the cohort. Primary analysis showed a >2-fold significant superiority of the digital screening in terms of AF detection (OR 2.12; P=0.010). In the second stage, this difference was even higher with an OR of 2.75 (P=0.003). “A new diagnosis of AF, as well as new prescription with oral anticoagulation was more frequent with digital screening than usual care, while there were no differences with respect to clinical outcomes,” Prof. Bauer elaborated. All in all, 85 new cases of AF were found by digital screening, 69% resulting from PPG-measurements with consecutive ECG confirmation. Usual care detected 40 new cases of AF. A time-dependent Cox regression found a significant prediction of major adverse cardiac and cerebrovascular events for AF (HR 6.13), abnormal PPG (HR 2.74), and PPG plus ECG-confirmed AF (HR 3.22).

“Only future studies can inform us, whether improved AF diagnostics through digital technology really translates into better treatment outcomes,” Prof. Bauer concluded.

  1. Bauer A. eBRAVE-AF - Smartphone-based AF screening. Hot Line Session 6, ESC Congress 2022, Barcelona, Spain, 26–29 August.


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