As a healthcare community, how are we taking action to detect AF and avoid the dangerous and costly sequelae that ensues?

The management of cardiac patients is a complex art and one that is continually evolving. After a symptomatic cardiac event, such as atrial fibrillation (AF), patients are moved through the continuum of care in what is often a reactive manner. In this patient subset, providers collect subjective data on the preceding events and then offer patients a wearable device to track and record ECG waveforms. This may be the gold standard for those with AF symptoms, but what about those at-risk patients who have a laundry list of comorbidities and have yet to present with a cardiac arrhythmia?

It is estimated that as many as 5 million Americans are living with AF (this number should double in the next two decades) and another estimated 600,000 adults who are undiagnosed.1 The most recent statistics from the American Heart Association2,3 confirm that we need a better process for monitoring the patients who are at-risk for AF:

  • Approximately 20% of patients who have a stroke due to AF are first diagnosed with AF at the time of stroke or shortly thereafter.
  • Top AF risk factors include hypertension (prevalent in 70% of adults >65), heart disease, and obesity.
  • 70% of AF episodes are considered silent, or without symptoms.
  • The death rate from AF, as the primary or contributing cause of death, has been rising for more than twenty years.

To summarize the data above, high blood pressure is a leading cause of AF (which affects many older adults), most AF patients have NO SYMPTOMS, and one-fifth of stroke patients didn’t know they even had AF. This costly arrhythmia is flying under the radar, largely undetected. With primary care providers tasked with managing this enormous patient population, we need an ECG screening solution that is an adjunct to lifestyle changes for prevention. We need a preventative tool that can mitigate the COST of ATRIAL FIBRILLATION SEQUELAE, one that alleviates both the financial cost to the payor and the personal cost to the patient.

picture1Cost to the Payor

Medical care is costly, and as the U.S. healthcare delivery system slowly shifts from reactive to preventative medicine, it is important to understand the financial impact of AF sequelae. AF is one of the most common causes of emergency department (ED) visits and, due to the overwhelming morbidity and mortality associated with AF, it has become a true public health and socioeconomic epidemic in the U.S.4 The national incremental cost of AF is estimated at $6 billion and growing.1

The list of AF sequelae is long and includes a two-fold risk increase for myocardial infarction and pulmonary embolus, three-fold risk increase for congestive heart failure, and a staggering five-fold risk increase for stroke.1 Stroke-related costs in the U.S. came to approximately $53 billion in a single year, which included the cost of all associated health care services and loss of productivity.5 ECG screening and early detection of AF can lead to early intervention and ultimately prevent the cascade of comorbidities that are driving increased ED visits, more costly interventions, and longer hospital admissions.

picture2Cost to the Patient

It is difficult to quantify the personal price paid by a patient when their health status is compromised. In addition to the financial burden caused by the downstream effects of AF, the physical, social, and psychological toll on the patient can be overwhelming.

Consider these qualitative costs to the patient when early detection and treatment for AF is missed:

  1. Loss of independence.
  2. Missed work and impact on income.
  3. Mental stress of new financial burdens.
  4. Shift in family dynamics.
  5. Dramatic changes in quality of life.

The catastrophic results of AF are complex, but perhaps none more than a stroke following this primary arrhythmia. The Quality of Life (QoL) assessment is an important tool in assessing disability in post stroke survivors. One study indicated that participants with functional impairments were common even two years after a stroke onset, including nearly half of patients experiencing sensory deficits and one-third having trouble with speech, motor, and memory function. 6

Improving Early Detection of Atrial Fibrillation

Although enhanced screening of AF has improved over the past decade, the asymptomatic population remains elusive to early detection and the overall burden to the health system and patients are largely underestimated. The hōm ecg+, when properly paired with the correct target patient population, provides a solution to improve early diagnosis of AF. This solution has the potential to reduce future hospitalizations, morbidity, and mortality.

The hōm ecg+ is a resource efficient tool that facilitates decision making and promotes clinical protocol compliance. The AF at-risk population can be better managed through monitoring, efficient diagnosis, and timely treatment.

References:

  1. https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.316340
  2. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.040267#:~:text=For%20between%2011.5%25%20and%2024,ECG%20monitoring%20after%20a%20stroke
  3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000748
  4. https://www.ahajournals.org/doi/full/10.1161/JAHA.118.009024
  5. https://www.cdc.gov/stroke/facts.htm
  6. https://pubmed.ncbi.nlm.nih.gov/24773696/