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Published on: December 11, 2019
NICE atrial fibrillation guideline snubs wearable technology: a missed opportunity?
Andre Briosa e Gala1, Michael Tb Pope2, Milena Leo3
1John Radcliffe Hospital, Oxford, UK and University of Southampton, Southampton, UK andre.gala@ouh.nhs.uk.
Insights
Wearable ECG devices offer excellent accuracy for detecting atrial fibrillation (AF), a common heart rhythm disorder. Early AF detection via these technologies could prevent strokes, despite current guideline limitations.
Area of Science:
- Cardiology
- Public Health
- Medical Technology
Background:
- Atrial fibrillation (AF) is a widespread cardiac arrhythmia and a significant public health concern.
- AF is linked to a quarter of all strokes, often presenting as the first symptom.
- An estimated 400,000 individuals in the UK remain undiagnosed for AF.
Purpose of the Study:
- To evaluate the diagnostic accuracy of wearable ECG devices for AF detection.
- To discuss the potential of wearable technology in reducing AF-related strokes.
- To address the discrepancy between wearable technology's capabilities and current clinical guidelines.
Main Methods:
- Analysis of diagnostic accuracy of single-lead ECG from advanced wearable devices.
- Comparison of wearable ECG interpretation with general practitioner interpretation of 12-lead ECG.
- Review of current National Institute for Health and Care Excellence (NICE) guidelines (NG196) regarding AF diagnosis.
Main Results:
- Diagnostic accuracy of the latest wearable ECGs for AF is excellent, often surpassing GP interpretation of 12-lead ECGs.
- High-quality ECGs from wearables can significantly expedite AF detection.
- Current NICE guidelines (NG196) do not recommend wearable technology for AF diagnosis.
Conclusions:
- Wearable ECG technology demonstrates high accuracy for identifying atrial fibrillation.
- There is a risk of delayed AF diagnosis and potential for preventable strokes if wearable technology is not integrated.
- Further consideration of wearable ECGs in AF detection strategies is warranted to mitigate patient risks.
Abstract:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a growing public health epidemic. In the UK, over 1.3 million people have a diagnosis of AF and an estimated 400,000 remain undiagnosed. AF-related strokes account for a quarter of all strokes and, as AF episodes are often asymptomatic, are still often the first manifestation of AF. Early diagnosis and initiation of oral anticoagulation, where appropriate, may prevent some of these thromboembolic strokes. Public Health England is committed to decrease the incidence of AF-related strokes and has sponsored initiatives aimed at improving AF detection by promoting the uptake of wearable technologies. However, the National Institute for Health and Care Excellence (NICE) has not recommended wearable technology in their recent AF diagnosis and management guidelines (NG196). Diagnostic accuracy of single-lead electrocardiography (ECG) generated by the latest iteration of wearable devices is excellent and, in many cases, superior to general practitioner interpretation of the 12-lead ECG. High-quality ECG from wearable devices that unequivocally shows AF can expedite AF detection. Otherwise, there is a real risk of delaying AF diagnosis with the potential of devastating consequences for patients and their families.
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