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Physician Preferences in Using Novel Digital Devices for the Management of Atrial Fibrillation-A DAS-CAM III Survey
Martin Manninger1,2, David Zweiker1,3, Tatevik Hovakimyan4
1Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria.
Insights
Physicians are increasingly using intermittent ECG devices for atrial fibrillation (AF) screening. Photoplethysmography (PPG) devices are rarely used for AF diagnosis, indicating a need for more education on digital health tools.
Area of Science:
- Cardiology
- Digital Health
- Medical Devices
Background:
- Recent European Heart Rhythm Association (EHRA) guidelines address novel digital devices for heart rhythm analysis.
- These devices utilize electrocardiogram (ECG) or photoplethysmography (PPG) technology for diagnosing atrial fibrillation (AF).
Purpose of the Study:
- To assess physicians' preferences for using digital devices in patients with suspected AF.
- To evaluate the impact of these devices on clinical decision-making.
Main Methods:
- An online survey was distributed to 505 physicians from 30 countries.
- Participants included electrophysiologists, cardiologists, cardiology residents, and general practitioners.
Main Results:
- Electrophysiologists showed higher experience with both ECG-based (92%) and PPG-based (60%) devices compared to non-electrophysiologists.
- Physicians rarely use PPG-based devices for AF diagnosis (8.2%-9.8%) but use ECG-based technology to confirm PPG findings.
- Electrophysiologists favored intermittent single-lead ECG monitoring over traditional Holter ECGs for AF screening.
Conclusions:
- Intermittent ECG-based digital devices are being adopted into clinical practice for AF management.
- Photoplethysmography (PPG)-based devices are currently underutilized for AF diagnosis and screening.
- Enhanced education is necessary to align clinical practice with EHRA guidelines for novel digital device utilization.
Aim:
A recent European Heart Rhythm Association (EHRA) practical guide provides guidance on the use of novel digital devices for heart rhythm analysis using either electrocardiogram (ECG) or photoplethysmography (PPG) technology for the diagnosis of atrial fibrillation (AF). This survey assesses physicians' preferences to use digital devices in patients with possible AF and their impact on clinical decision-making.
Methods And Results:
Participants of the DAS-CAM III initiated and distributed an online survey assessing physician preferences in using digital devices for the management of AF in different clinical scenarios. A total of 505 physicians (median age: 38 [IQR 33-46] years) from 30 countries completed the survey. A third of respondents were electrophysiologists, the others were cardiologists, cardiology residents, or general practitioners. Electrophysiologists were more likely to have experience with both ECG-based (92% vs. 68%, p < 0.001) and PPG-based (60% vs. 34%, p < 0.001) digital devices. The initial diagnostic approach to each scenario (symptomatic low-risk, symptomatic high-risk, or asymptomatic high-risk patient) was heterogeneous. Electrophysiologists preferred intermittent single-lead ECG monitoring to traditional Holter ECGs to screen for AF. Both electrophysiologists and non-electrophysiologists would rarely use PPG-based devices to diagnose and screen for AF (8.2%-9.8%). Electrophysiologists and non-electrophysiologists use ECG-based technology to confirm PPG-documented tracings suggestive of AF.
Conclusion:
While PPG-based digital devices are rarely used for diagnosis and screening for AF, intermittent ECG-based digital devices are beginning to be implemented in clinical practice. More education on the potential of novel digital devices is required to achieve diagnostic pathways as suggested by the EHRA practical guide.
