Novel Smartphone Screening Program Detects Atrial Fibrillation in Native Americans

A unique smartphone-based electrocardiogram (ECG) screening accurately detected previously unknown atrial fibrillation in Native Americans and in doing so might have prevented ischemic strokes.

The technology study, detailed in a recent Journal of the American Heart Association article, is just one example of how smartphones are being utilized more often in every aspect of healthcare, from clinical research studies to patient care. Researchers at Memorial Sloan Kettering Cancer Center in New York City are also in the process of testing the effectiveness of mobile technology intervention on breast cancer patients' self-management of the oral anticancer medication Ibrance (palbociclib).

Related: Self-management Being Put to the Test in MSK Study of Patients Taking Ibrance

In this study of Native American, more than 1,000 participants underwent a 30-second, single-lead ECG using the mobile device paired with a tablet or smartphone at a tribal clinic. Then researchers compared the ECG results of the screened participants to the results of a control group who did not receive the mobile-based ECG screening.

The researchers discovered atrial fibrillation in 1.5% of patients in the smartphone ECG program versus 0.3% of patients in the control group.

Of the patients diagnosed with atrial fibrillation, 14 had a high risk of stroke, as measured by the CHADS2-VASc score (the standard measure to calculate stroke risk) and met the criteria for initiation of blood-thinning medication.

Notably, around half of those diagnosed with atrial fibrillation by mobile-based ECG were younger than the recommended screening age of 65 years old.

The findings are important because about one-third of ischemic strokes, are caused by atrial fibrillation, the most common heart rhythm disorder, the American Heart Association said in a press release. “Since many people don’t have symptoms and are unaware of its presence, atrial fibrillation often goes undiagnosed. In some cases, a stroke is the first sign that a person has the disorder,” AHA said.

Moreover, Native Americans are more at risk for atrial fibrillation than people in other racial and ethnic groups. “As a population, American Indians also have substantially higher rates of obesity, diabetes and high blood pressure — all risk factors for atrial fibrillation,” noted the AHA press release.

Stavros Stavrakis

“Systemic screening among American Indians has never been done before, and the true rate of atrial fibrillation in this population is unknown," said lead study author Stavros Stavrakis, M.D., Ph.D., a cardiologist at the Heart Rhythm Institute of the University of Oklahoma Health Sciences Center and associate professor of medicine at the University of Oklahoma College of Medicine in Oklahoma City.

“Our study shows that we have a very simple and accurate method to screen and diagnose atrial fibrillation that is easy to implement at tribal clinics. This widely-available, low-cost approach has real potential to improve health outcomes among American Indians,” Stavrakis added.

American Indians develop cardiovascular diseases at earlier ages than the national average, AHA said, and more than one-third of deaths attributed to cardiovascular disease in American Indians occur before 65 years old.

“In a targeted, high-risk population such as American Indians, our results showed screening at a younger age found many cases of atrial fibrillation that would have been missed following current age recommendations,” Stavrakis said. “We have the potential to improve outcomes in this population by initiating early treatment.”

The study was funded by the National Institute of Minority Health and Health Disparities of the National Institutes of Health.