Outsmarting AFib with a Smartphone

by Allan Platt, PA-C, MMSc, DFAAPA

Phillip is a 55 year old male who was seen in the ED 2 weeks ago for a rapid heart rate. He was diagnosed with new onset atrial fibrillation with a rapid ventricular response of 120. Since he could pin point the time when it began and it was within 10 hours, and he had no past history of hypertension , diabetes, heart disease or AFib, the ED PA elected to cardiovert Phillip. This was successful first try and Phillip has maintained normal sinus rhythm and is coming to you as primary care provider for a follow-up. He was also sent for an outpatient cardiac echo that was normal 1 week ago.

Does Phillip need anticoagulation to prevent a stroke?

Are there smartphone apps that Phillip can use to help manage his AFib?

The American College of Cardiology (ACC)  has a stroke risk calculator free at http://www.acc.org/anticoagevaluator

AnticoagEvaluator helps clinicians make informed decisions on antithrombotic therapy for their non-valvular AF patients.

The app has the following resources:

  • Calculate a patient’s stroke risk (CHA2DS2-Vasc), bleed risk (HAS-BLED and concomitant meds), and renal function (Cockroft-Gault Equation)
  • Review stroke prevention therapy guidance based on ACC/AHA/HRS’s 2014 Guidelines for the Management of Patients with Atrial Fibrillation
  • Improve accurate use of DOACs with adjusted dosage based on prescribing information, fine-tuned for renal and other patient characteristics
  • Determine appropriate therapy for a patient by reviewing
      • Synthesized individualized risk for antithrombotic therapy options based on clinical trials (e.g., ACTIVE-A, RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE-AF)
      • Relevant safety information and full prescribing information for all therapy options

If you enter Phillips data in the stroke risk calculator, you see he is low risk and does not require anticoagulant therapy.  A Patient centered app is the free ACC CardioSmart Heart Explorer app for iOS (iPhone/iPad) and Android. It has heart graphics and lay education about AFib and other heart conditions. See all the free ACC apps at http://www.acc.org/tools-and-practice-support/mobile-resources?w_nav=MN#Clinical

AliveCor  has developed KardiaMobile a $99  miniaturized ECG device with 2 silver electrodes held by fingers of right and left hands. It is can be attached the back of an android or iOS smartphone or carried in a packet case. Recording is activated by holding the device, which transmits to the smartphone to the free app. The ECG is displayed on the smartphone, with automated AF diagnosis after 30 seconds of recording This reading can be stored or transmitted to a central website or accessed by or emailed to your clinician. There is a new Apple watch application and sensor. See all the details at https://www.alivecor.com and this can be ordered on Amazon. The app is Google play or iTunes.

This new affordable technology is making smart phones smarter and patients partners in their treatment plan.





See Allan Platt, PA-C, MMSc, DFAAPA speak at the GAPA 2018 Summer Conference July 15-19 in Sandestin, FL.

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