Atrial fibrillation (AF) challenges primary care in many ways.
Atrial fibrillation is the most common sustained cardiac arrhythmia and is associated with a higher risk of cardiovascular disease (CVD) and death.
not only with a five times Increased risk of stroke, up to 25% of stroke patients develop AF, but AF-related stroke also more serious due to higher mortality and greater disability. a study AF has also been found to be the direct cause of 5% of congestive heart failure cases and has been established in up to 50% Patients with severe heart failure.
Therefore, the total direct medical cost of AF patients is estimated to be 73% higher than the matched control group. This places a heavy financial burden on the entire healthcare system. Latest data for 2011, AF is estimated Bears up to $26 billion in U.S. health care costs each year. The main driver of cost is hospitalization.
These costs will only continue to climb as the prevalence of AF increases Increase remarkably consistent with growth most dangerous Patient population; people over 50 years old. 3-6 million There are AF patients in the United States in 2020.Its prevalence has increased 33% In the past 2 years alone, it is estimated to increase in the next 30 years 2.5 timesone of the greatest pandemic and public health challenges we face.
So, where does primary care come from?
Due to the nature of disease progression and the low chance of diagnosis and intervention within the clinically recognized “golden 6 months”, rising prevalence is driving increased hospitalizations, and therefore costs.
This 6-month golden period is the pre-diagnostic and diagnostic phase of the patient journey, where primary care screening enables various forms of prevention;
- primitive (i.e. prevention of risk factors through healthy lifestyle interventions),
- Primary (i.e. prevention of onset by reducing risk factors such as weight loss, hypertension, and diabetes control), and
- Secondary (i.e. providing early diagnosis and preventing complications).
During the first 6 months, patients initially enter paroxysmal AF, with episodes of arrhythmia that terminate on their own, lasting no more than 7 days, and usually lasting less than 24 hours.Due to the ephemeral nature of these events, and 10-40% Attacks of AF are asymptomatic, and paroxysmal AF is difficult to diagnose, so opportunities for prevention (as described above) are limited.
Without effective prevention, the frequency and severity of AF episodes (in the form of an increase in heart rate) develop as the patient’s symptoms worsen and progress into persistent AF, so episodes do not end on their own, lasting longer than 7 days, requiring medication or electrical cardioversion termination. beyond this, 40% of persistent AF patients will develop permanent AF within one year of diagnosis, so no therapeutic intervention can successfully terminate AF.
The main challenge facing primary care is the current lack of universal screening, which greatly reduces our ability to detect patients early in this golden window.Anticoagulation can prevent peripheral two thirds AF-related stroke, so overcoming this diagnostic hurdle is critical.
Current screening methods are limited to opportunistic pulse palpation during outpatient appointments. If AF is suspected during pulse palpation, an electrocardiogram (ECG/EKG) will be used to confirm the diagnosis; 12-lead ECG or Holter in a clinical setting, as a Holter/event monitor or as a loop implanted under the skin of the chest Recorder wear, which is more effective in diagnosing paroxysmal AF. More recently, FDA-approved portable ECGs are also available in the following formats: liveKohl’s Cadia Mobile equipment.
In any event, none of these screening methods will be sufficient to facilitate the population-wide screening needed and halt the development of this epidemic and its pressure on our healthcare services. Primary care services are already stretched thin, and having every member of the public come in for pulse palpation is not an option.
Therefore, innovation is being ramped up to find the estimated 1-2% of the U.S. population with undiagnosed AF, which could improve the ability to screen for opportunistic AF and go beyond that to facilitate early diagnosis of the population—at scale.
Recent advances in remote monitoring technology include the application of machine learning algorithms to accurately measure vital signs and other physiological parameters, including heart rhythm and AF detection, from only smartphone sensor data; no additional equipment is required.
Built into a patient-friendly smartphone app that forms a real-time communication channel with care providers, this scalable, population-wide screening tool may offer golden opportunities, minimize barriers to diagnosis, and contribute to more timely interventions that improve patient outcomes and streamline primary care workflows while reducing overall cost of care.
Not only would this allow primary care providers to facilitate early diagnosis and find more patients in their “golden 6-month window”, but it would also allow for an aggressive preventative approach to diagnosing and managing AF to stop the epidemic at its source and improve the lives of millions of people around the world.
Photo: hudiemm, Getty Images
