iPhone app with ECG a candidate for mass AF screening

The University of Sydney is trialling the AliveCor health monitor for iPhone device in general practices in Sydney, following research that found it was highly successful in screening for atrial fibrillation in community pharmacies.

The AliveCor device is a single-lead ECG device built into an iPhone case that has an accompanying app that can analyse the readings and display them on the phone's screen.

The electrodes are rested on the fingers from each hand, and the app senses skin contact on the sensors. The app can be set to take 30-second or continuous rhythm strips.

The device has been trialled in community pharmacies in research led by PhD candidate Nicole Lowres as part of a postgraduate scholarship funded by the National Heart Foundation.

Ms Lowres said her research had shown it was a cost-effective tool for mass screening in pharmacies, and it was now being used as part of a trial by practice receptionists. Patients are screened before they see the GP, with the results ready in time for the consultation.

The device is available in the US following approval as a medical device by the US Food and Drug Administration, but it is only available for purchase by health professionals and consumers by prescription. It was also recently released in the UK and Ireland.

Ms Lowres said the device has been approved by Australia's Therapeutic Goods Administration and she understands it will be available here in the very near future.

Ben Freedman, a professor of cardiology and deputy dean of medicine at the University of Sydney's Concord Clinical School, presented research at the Australia and New Zealand Cardiac Society conference on the Gold Coast last week showing that the use of the device was a highly effective, accurate and cost-effective way to screen patients to identify previously undiagnosed AF and help prevent strokes.

Professor Freedman said in a statement that the iECG would allow clinicians to screen patients for AF in minutes, and treat people early.

“This is a huge boost in the fight to reduce the amount of strokes, particularly in people over the age of 65," he said.

The device snaps onto the back of an iPhone to record, display, store and transfer single-lead ECG rhythms wirelessly with the AliveECG app. Recorded rhythm strips are stored in the app and sent to a secure server that can automatically analyse the reading.

It can also be sent securely to the cloud in PDF format for review by a cardiologist.

The University of Sydney research team, as part of its Screening Education And Recognition in Community pHarmacies of Atrial Fibrillation (SEARCH-AF) stroke prevention study, found that the website's automatic prediction was able to correctly diagnose AF 97 per cent of the time.

Earlier research by the team had validated the algorithms used.

Ms Lowres said part of the SEARCH-AF project looked at patients' understanding of their disease, and found some alarming results.

"Over half of those with known atrial fibrillation at the time of screening were unaware of their diagnosis even though many of them were prescribed and taking warfarin to treat their condition," she said.

In the SEARCH-AF trial, 10 pharmacies were recruited and screening offered to all customers over the age of 65. Each screen took less than five minutes to complete and consisted of a brief medical history, pulse check and a single lead iECG.

Of the 1004 participants screened, one per cent were found to have previously unknown AF and an additional half a per cent were re-identified with AF.

The researchers found that the automated algorithm had high accuracy for identification of AF with 97 per cent sensitivity and 92 per cent specificity.

Ms Lowres said it was a cost-effective screening tool. Pharmacies are being encouraged to offer more screening options as part of a federal government incentive program.

“Our economic analysis has shown the iECG is highly cost effective and in fact this is the first mass screening program for AF likely to be cost effective, unlike traditional 12-lead ECGs recorded by a practice nurse," she said.

"In addition, the iECG is extremely portable, which gives great flexibility for screening, and is simple to administer."

The research also showed that only 66 per cent of those eligible for stroke prevention medication were being prescribed it.

iMedicalApps recently published a comprehensive review of the device.

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