Community AF screening with iECG feasible and cost effective

A Sydney research team that has been trialling the use of the AliveCor heart monitor and iPhone ECG device in both community pharmacies and general practice has found that it is both a feasible and a cost-effective way to better screen older people for atrial fibrillation (AF), one of the leading causes of stroke.

The AliveCor device is a single-lead ECG built into an iPhone case that has an accompanying app that can analyse the readings and display them on the phone's screen. The readings are sent to a secure website, where an algorithm can predict AF with 97 per cent accuracy. They can also be stored for review by specialist cardiologists.

Last year, the team published encouraging results from its Screening Education And Recognition in Community pHarmacies of Atrial Fibrillation (SEARCH-AF) stroke prevention study, which involved 10 pharmacies where screening was offered to all customers over the age of 65.

The pharmacists were trained in how to approach patients, how to use the device and what they should look for. Those proving positive for AF were referred to their doctor. 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 team has also been trialling the device in the general practice setting, studying its use by GPs themselves as well as for pre-consultation screening by receptionist staff and practice nurses.

In an qualitative study published last month in Australian Family Physician, the team reported that GPs were very positive about the device because of its ease of use and portability compared to a 12-lead ECG. Practice nurses were also keen on using it and were very confident in doing so, but receptionists were far more reluctant and were not convinced it fitted their role in the surgery.

That study also found that GPs thought iECG screening was useful as a prompt to concentrate on cardiovascular health.

Now, the team has published the results of its analysis of the feasibility of using the device on a greater scale in community pharmacies, as well as the cost-effectiveness for funding bodies to do so. The argument is that stroke is highly preventable in AF using warfarin or novel oral anti-coagulants but that there are large treatment gaps.

UK research has shown that systematic screening in general practice using 12-lead ECG was not cost-effective, the researchers write, and a Cochrane review of systematic screening showed that there was a need to examine alternative screening strategies.

In the journal Thrombosis and Haemostasis, the team writes that community screening using the iECG is feasible and cost effective. They found that the incremental cost-effectiveness ratio (ICER), based on 55 per cent warfarin prescription adherence, would be $5988 per quality adjusted life year gained (QALY) and $30,481 for preventing one stroke.

The costs include $20 per iECG screen, $252 for diagnostic assessment of AF (GP consult, specialist consult and 12-lead ECG) and $803 per annum for warfarin treatment, INR monitoring, three GP visits and one specialist visit.

“The estimated ICER of screening to prevent one stroke or to increase one QALY is well within the range that would be fundable on a population basis, using either warfarin or (novel oral anti-coagulants),” the researchers write.

“The high and largely preventable stroke/thromboembolism risk of those with newly identified AF highlights the likely benefits of community AF screening. Guideline recommendation of community iECG AF screening should be considered.”

In Australia, the device is TGA approved and is being distributed by Sydney company uHealth for $299. The heart monitor itself fits on most mobile devices and the accompanying app is available for iPhone and Android. Consumers are provided with secure storage and sharing functionality.

Healthcare providers are also equipped with a free web app that acts as a dashboard to help review their patient's ECG data.

Posted in Australian eHealth

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