How Wearable Technology is Playing a Role in Diagnosis, Patient Health
Chances are good you’ve heard about atrial fibrillation (AFib), a condition that affects some 2.7 million Americans, according to the American Heart Association. But did you know that technologies the patient actually wears are being prescribed increasingly to treat AFib? We asked Brian Lé, M.D., a cardiologist on the medical staff at Texas Health Dallas and at Cardiology and Interventional Vascular Associates, a Texas Health Physicians Group practice, to help us better understand AFib and how wearable technologies are playing a role in helping consumer recognize symptoms.
Before we talk about wearable technology, what can you tell us about AFib?
AFib or atrial fibrillation is an irregular, fast heart rhythm where the upper chambers of the heart are “quivering” at 300-500 beats per minute, beating irregularly and out of sync with the lower chambers of the heart. As a result, the heart’s ability to pump blood properly is compromised. When AFib occurs, there is a stagnation of blood flow, which increases the risk of clot formation, leading to a stroke. Those affected by AFib will experience fatigue, dizziness, and a general sense that they don’t feel like themselves.
I seem to hear more about AFib today than in the past. Why is that?
It is true we hear more about AFib because we are living longer, so the number of people who need treatment increases. AFib is also more familiar because of print and TV advertising.
Who is most affected by AFib?
The typical AFib patient is obese with a Body Mass Index (BMI) of greater than 25. Most patients are 60 or older and live a sedentary lifestyle with hypertension and obstructive sleep apnea (OSA).
How is AFib diagnosed?
AFib is diagnosed with an electrocardiogram (ECG) test or a type of heart monitor that identifies the irregular, fast heartbeat. Half of patients have no awareness that they are experiencing AFib, while the other half experience fatigue, shortness of breath, and heart palpitations. If a patient is experiencing symptoms, he or she will need to seek treatment and evaluation right away. For those without symptoms, AFib can be detected on a routine physical exam by a Primary Care Physician or doing a pre-op evaluation of an elective surgery or post-surgery.
How is wearable technology playing a part in treating/diagnosing AFib?
Wearable technology helps physicians identify AFib in real time with or without the patient symptoms. Technology allows quicker visits to the healthcare provider for evaluation and treatment and gives us the opportunity to slow or stop its progression. You may be interested to know that AFib has stages, like cancer, that allow us to predict prognosis. Wearable technology helps us do that.
What are wearable technology options? How do they work?
The traditional wearable technologies are the Holter and Event portable ECG monitors that health care providers use by attaching electrodes to the patient to record heart rhythm. This technology is considered the gold standard for its accuracy and documentation of symptoms associated with heart rhythm.
Newer technologies allow the patient to wear a patch on the chest to record heart rhythms. The patient can even shower with this wearable technology, unlike the Holter and Event monitors. Another technology involves a metal platform on an Apple watch so the patient may press her thumb against the device to record a single electrode heart rhythm on the watch or iPhone. The devices can store the 30-second tracking as a pdf file and notify the monitoring center if AFib is noted.
Yet another wearable technology option involves using plethysmography, an instrument for measuring an organ’s change in volume, to detect blood flow that can recognize AFib. A benefit of this technology is that it doesn’t require the patient to have symptoms. When an irregular heart rhythm is detected, the device can notify a monitoring center that the patient is experiencing AFib, sending a notification to the patient’s physician for further treatment and action.
Last, there is a small implantable loop monitor that can continuously record the patient’s heart rhythm with self-activation and recording if AFib is detected. With this technology, the patient has a home monitor that transmits recorded data to the physician’s office once a month.
You were recently on TV speaking about the WATCHMAN device that’s implanted in the heart. How does this technology work?
WATCHMAN is an implantable device that blocks the left atrial appendage where blood clots tend to form when the patient is in AFib. It reduces the risk of stroke similarly to Warfarin without having to be on a blood thinner. We reserve this technology for patients who are not long-term candidates for blood thinners due to a higher risk of bleeding, or those with active lifestyles that may increase the risk of bleeding, or labile Internalized Normal Ratio (INR) patients taking Warfarin or in compliance with medications that can reduce the risk of stroke.