1. The Incidence of Undiagnosed AF Could be as High as 40%
No one would argue against the value of finding these currently undiagnosed AF patients. But with increased screening intensity comes increased cost, complexity, and burden on the patient, the clinician, and the health care system. And it raises the question of whether every patient with even the smallest burst of AF needs to be treated. Perhaps more intense screening is moving in the wrong direction, and instead, we should concentrate on making spot-screening tools more effective, cheaper, and more available?
2. Over 1 in 5 Patients with AF Suffers a Stroke Before Their AF is Diagnosed
3. Undiagnosed and Under-treated AF Adds Billions to Medical Spending
4. AF is Very Treatable if Caught Early
5. Cost-effective Early Detection Tools Are Now Widely Available
An added benefit of these inexpensive, software-enabled, patient-friendly rhythm monitoring devices is that they will become more valuable over time as the software and hardware improve. For example, one point-of-care cardiac assessment tool, the Eko DUO, allows for frequent, low-cost capture of heart rhythm and sounds in an outpatient or home care setting. Since it serves as the physician’s stethoscope, it would be applied to every patient that the physician examines. This means a device costing only a few hundred dollars that can screen for AF with 99% sensitivity, when used on thousands of patients per year, per physician, can drop the cost per screening to pennies.And because the DUO is a platform for machine learning software algorithms, it will only continue to improve: Currently, the DUO can detect AF and rapid or slow rhythms, but soon it will also be able to detect problems with the heart’s pumping function and other abnormalities.
Low profile, convenient, and digitally augmented tools like the DUO can help providers shift efforts targeting AF detection from “not cost-effective” to “very cost-effective.” They will be able to perform frequent ECG assessments during physical and virtual encounters that are faster, less cumbersome, and cheaper than using a 12-lead or ordering an ambulatory monitor. This can be particularly impactful for primary and geriatric care professionals that frequently encounter older patients who are at high risk for AF or stroke. It’s likely that low-cost and convenient devices like DUO could eventually serve as monitoring devices over the longer term, helping physicians keep track of their patients who are on drug therapies forAF or recovering from procedures such as heart surgery where AF is an extremely common and dangerous complication.
So, where do we go from here? We must generate evidence that screening patients with these devices is truly cost-effective and has a positive impact on patients and health care. That evidence will move the needle toward adopting AF screening as the standard of care and help reduce the burden of this terrible disease.