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Comment on “Assessment of remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: The REHEARSE-AF Study”
Comentário sobre «Avaliação remota do ritmo cardíaco com o uso do monitor cardíaco AliveCor para rastreio de fibrilhação auricular: Estudo Rehearse-AF»
Alexandra Gonçalves
Membro do Corpo Redatorial da Revista Portuguesa de Cardiologia, Lisboa, Portugal
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cardiac magnetic resonance imaging in 2-chamber long-axis view showing projections of apparently compacted myocardium originating from the left ventricular inferior wall (C); cardiac magnetic resonance imaging in axial 4-chamber view showing projections of apparently compacted myocardium originating from the left ventricular inferior wall and the left side of the interventricular septum (D and E).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bárbara de Pinho Cardoso, Conceição Trigo, Nuno Jalles Tavares, Fátima F. 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Pinto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255117303621" "doi" => "10.1016/j.repc.2017.01.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117303621?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917302970?idApp=UINPBA00004E" "url" => "/21742049/0000003600000011/v1_201712190639/S2174204917302970/v1_201712190639/en/main.assets" ] "pt" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Rcommended Article of the Month</span>" "titulo" => "Comment on “Assessment of remote heart rhythm sampling using the AliveCor heart monitor to screen for atrial fibrillation: The REHEARSE-AF Study”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "877" "paginaFinal" => "878" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Alexandra Gonçalves" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Alexandra" "apellidos" => "Gonçalves" "email" => array:1 [ 0 => "alexandra.goncalves@alumni.harvard.edu" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Membro do Corpo Redatorial da Revista Portuguesa de Cardiologia, Lisboa, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Comentário sobre «Avaliação remota do ritmo cardíaco com o uso do monitor cardíaco AliveCor para rastreio de fibrilhação auricular: Estudo Rehearse-AF»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par1090" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb1005"></elsevierMultimedia></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Abstract</span><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Background:</span></span> Asymptomatic atrial fibrillation (AF) is increasingly common in the aging population and implicated in many ischemic strokes. Earlier identification of AF with appropriate anticoagulation may decrease stroke morbidity and mortality.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Methods:</span></span> We conducted a randomized controlled trial of AF screening using an AliveCor Kardia monitor attached to a WiFi‐enabled iPod to obtain ECGs (iECGs) in ambulatory patients. Patients ≥65 years of age with a CHADS‐VASc score ≥2 free from AF were randomized to the iECG arm or routine care (RC). iECG participants acquired iECGs twice weekly over 12 months (plus additional iECGs if symptomatic) onto a secure study server with overread by an automated AF detection algorithm and by a cardiac physiologist and/or consultant cardiologist. Time to diagnosis of AF was the primary outcome measure. The overall cost of the devices, ECG interpretation, and patient management were captured and used to generate the cost per AF diagnosis in iECG patients. Clinical events and patient attitudes/experience were also evaluated.</p><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Results:</span></span> We studied 1001 patients (500 iECG, 501 RC) who were 72.6±5.4 years of age; 534 were female. Mean CHADS‐VASc score was 3.0 (heart failure, 1.4%; hypertension, 54%; diabetes mellitus, 30%; prior stroke/transient ischemic attack, 6.5%; arterial disease, 15.9%; all CHADS‐VASc risk factors were evenly distributed between groups). Nineteen patients in the iECG group were diagnosed with AF over the 12‐month study period versus 5 in the RC arm (hazard ratio, 3.9; 95% confidence interval=1.4‐10.4; P=0.007) at a cost per AF diagnosis of $10780 (£8255). There was a similar number of stroke/transient ischemic attack/systemic embolic events (6 versus 10, iECG versus RC; hazard ratio=0.61; 95% confidence interval=0.22‐1.69; P=0.34). The majority of iECG patients were satisfied with the device, finding it easy to use without restricting activities or causing anxiety.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">Conclusion:</span></span> Screening with twice‐weekly single‐lead iECG with remote interpretation in ambulatory patients ≥65 years of age at increased risk of stroke is significantly more likely to identify incident AF than RC over a 12‐month period. This approach is also highly acceptable to this group of patients, supporting further evaluation in an appropriately powered, event‐driven clinical trial.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Clinical Trial Registration – URL: <a href="https://www.isrctn.com/">https://www.isrctn.com</a>. Unique identifier: ISRCTN10709813.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Comment</span><p id="par0030" class="elsevierStylePara elsevierViewall">O estudo Rehearse‐AF,<span class="elsevierStyleSup">1</span> apresentado no Congresso Europeu de Cardiologia 2017 e simultaneamente publicado na revista <span class="elsevierStyleItalic">Circulation</span>, mostrou que o uso do <span class="elsevierStyleItalic">smartphone</span> com uma derivação de ECG duas vezes por semana, por doentes idosos com fatores de risco para FA, detecta mais casos de fibrilhação auricular assintomática comparativamente com o seguimento clínico convencional.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Era já do nosso conhecimento que a probabilidade de detecção de FA aumenta com a intensidade da procura, contudo a prova de capacidade diagnóstica com o simples e cômodo uso de um <span class="elsevierStyleItalic">smartphone</span> de forma intermitente é altamente inovador e faz‐nos refletir sobre as potencialidades desses dispositivos para a melhoria da prática clínica e eventualmente <span class="elsevierStyleItalic">outcomes</span> dos nossos doentes. Esse estudo não foi desenhado com poder suficiente para avaliar <span class="elsevierStyleItalic">outcomes</span> e claramente são necessários estudos adicionais para justificar os custos associados e clarificar o impacto clínico do uso deste tipo de dispositivo para detecao de FA.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflitos de interesse</span><p id="par0045" class="elsevierStylePara elsevierViewall">A autora declara não haver conflitos de interesse.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflitos de interesse" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:5 [ "identificador" => "tb1005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "<span class="elsevierStyleSections"><p id="par1080" class="elsevierStylePara elsevierViewall">Julian P.J. Halcox, Kathie Wareham, Antonia Cardew, Mark Gilmore, James P. Barry, Ceri Phillips, Michael B. Gravenor. Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study. Circulation. 2017;CIRCULATIONAHA.117.030583.</p></span>" ] ] ] ] "idiomaDefecto" => "pt" "url" => "/21742049/0000003600000011/v1_201712190639/S2174204917303264/v1_201712190639/pt/main.assets" "Apartado" => array:4 [ "identificador" => "9913" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Recommended article of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000011/v1_201712190639/S2174204917303264/v1_201712190639/pt/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917303264?idApp=UINPBA00004E" ]
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ISSN: 21742049Original language: Portuguese
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