A year-long pilot program in Australia to screen for for atrial fibrillation (AF) found new, previously undiagnosed AF in 1.5% of those tested. The SEARCH-AF study used the AliveCor Heart Monitor ECG to test 1,000 customers 65 years and older through community screening in suburban Sydney pharmacies. Pharmacists used the AliveCor device, attached to an iPhone, to transmit 30-60 second ECG recordings to study cardiologists. If AF was suspected, the follow-up was a GP review and a 12-lead ECG performed. AF is the most common heart rhythm abnormality and puts an individual at five times the risk for stroke (National Stroke Association). Early diagnosis and treatment cost savings are straightforward: over $20,000 (~£12,400) for prevention of one stroke. (This Editor’s opinion–it’s an understatement.) Per the study summary:
The incremental cost-effectiveness ratio of extending iECG screening into the community, based on 55% warfarin prescription adherence, would be $AUD5,988 (€3,142; $USD4,066) per Quality Adjusted Life Year gained and $AUD30,481 (€15,993; $USD20,695) for preventing one stroke. (“Feasibility and cost effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies”, Thrombosis and Haemostasis, Ben Freedman, MD et al., 1 April online (subscription access required for full study)
15 new AF diagnoses per 1,000 may not sound high, but using the above estimate, this type of community screening using AliveCor or a similar device translates to a cost saving of over $310,425, assuming that all undiagnosed AF resulted in a stroke. Even if less, it is a nice return on investment, health and future outcomes. (This Editor invites more accurate cost analysis.) AliveCor release (San Francisco Business Times). Additional coverage CNet Australia. The George Institute for Global Health Australia project page which extends the study to GP clinics.
Hello Donna – nice recap of this Australian study. A couple reflections on assumptions here: first, as Florida physician Dr. Howard Green once described a much-publicized event in which AliveCor was used to diagnose AFib in an airline passenger experiencing distressing symptoms:
“A simple finger on the wrist also can diagnose this arrhythmia.”
The other assumption is that “all undiagnosed AF results in a stroke”. About 15% of strokes are caused by atrial fibrillation. Another assumption: an optimistic 55% adherence to Warfarin (a high-maintenance drug). Many studies (e.g. Casciano et al J Manag Care Pharm. 2013 May;19(4):302-16) show good Warfarin adherence is more like 21%.
The most common cause of atrial fibrillation is longstanding, uncontrolled high blood pressure – which is why community blood pressure screening programs are so important.
My own assumption: This study will help to expand the retail market for AliveCor beyond the (relatively small) market of individual heart patients at risk for cardiac arrest.
Thanks for sharing this.
regards,
C.
Carolyn–thanks for your POV which as ‘Heart Sister’and ‘Ethical Nag’ is always well-informed. I’d say that while a finger on the wrist can initially diagnose AF, having a quick ECG (and, as you pointed out, a BP reading) trumps that. Also, the ‘community screening’ setting and perhaps the novelty of using AliveCor can interest the otherwise uninterested into a quick test in a convenient setting.
Recalculating: assuming that the 15 percent AF>stroke rate applies equally to the undiagnosed and that it is not higher for being undiagnosed, it is 2.25 persons at $46,564 cost saving. (Again, I believe the cost saving is restricted and is not, as we used to calculate in the airline business, fully allocated.)
It is probably too soon to tell if the new blood thinners such as Pradaxa have a higher adherence rate than warfarin.