Consumer-Led Screening for Atrial Fibrillation: A Report From the mAFA-II Trial Long-Term Extension Cohort

Yutao Guo; Hui Zhang; Gregory Y H Lip; mAF-App II Trial investigators

doi:10.1016/j.jacasi.2022.07.006

Consumer-Led Screening for Atrial Fibrillation: A Report From the mAFA-II Trial Long-Term Extension Cohort

JACC Asia. 2022 Nov 1;2(6):737-746. doi: 10.1016/j.jacasi.2022.07.006. eCollection 2022 Nov.

Authors

Yutao Guo¹, Hui Zhang¹, Gregory Y H Lip^{2

3}; mAF-App II Trial investigators

Affiliations

¹ Medical School of Chinese PLA, Department of Pulmonary Vessel and Thrombotic Disease, Sixth Medical Center, Chinese PLA General Hospital, Beijing, China.
² Liverpool Centre for Cardiovascular Sciences, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
³ Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.

Abstract

Background: There are limited data on mobile health detection of prevalent atrial fibrillation (AF) and its related risk factors over time.

Objectives: This study aimed to report the trends on prevalent AF detection over time and risk factors, with a consumer-led photoplethysmography screening approach.

Methods: 3,499,461 subjects aged over 18 years, who use smart devices (Huawei Technologies Co.) were enrolled between October 26, 2018, and December 1, 2021.

Results: Among 2,852,217 subjects for AF screening, 12,244 subjects (0.43%; 83.2% male, mean age 57 ± 15 years) detected AF episodes. When compared with 2018, the risk (adjusted HRs, 95% CI) for monitored prevalent AF increased significantly for subjects when monitoring started in 2020 (adjusted HR: 1.34; 95% CI: 1.27-1.40; P < .001) or in 2021 (adjusted HR: 1.67; 95% CI: 1.59-1.76; P < 0.001). Of the 961,931 subjects who screening for both AF and OSA, 18,032 (1.9%, 97.8% male, mean age 44 ±17 years) were identified as high risk for OSA, which resulted in a 1.5-fold increase (95% CI: 1.30-fold to 1.75-fold) in the prevalent AF. A total of 5,227 (53.3%, 5,227/9,797) subjects were effectively followed up, from which 4,903 (93.8%, 4,903/5,227) subjects were confirmed with the diagnosis of AF, by the mAFA Telecare Team health providers.

Conclusions: Photoplethysmography-based smart devices can facilitate screening for AF with >93% confirmation of detected AF episodes even for the low-risk general population, highlighting the increased risk for detecting prevalent AF and the need for modification of OSA that increase AF susceptibility. (Mobile Health [mHealth] Technology for Improved Screening, Patient Involvement and Optimizing Integrated Care in Atrial Fibrillation [mAFA (mAF-App) II study]; ChiCTR-OOC-17014138).

Keywords: AF, atrial fibrillation; AHI, apnea hypopnea index; CAD, coronary artery disease; ECG, electrocardiogram; OSA, obstructive sleep apnea; PPG, photoplethysmography; atrial fibrillation; mHealth, mobile health; obstructive sleep apnea syndrome; photoplethysmography; prevalence; smart devices.