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. 2022 Jan;22(1):77-82.
doi: 10.7861/clinmed.2021-0436.

NICE atrial fibrillation guideline snubs wearable technology: a missed opportunity?

Andre Briosa e Gala  1 , Michael Tb Pope  2 , Milena Leo  3 , Trudie Lobban  4 , Timothy R Betts  5
Affiliations

NICE atrial fibrillation guideline snubs wearable technology: a missed opportunity?

Andre Briosa e Gala et al. Clin Med (Lond). 2022 Jan.

Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a growing public health epidemic. In the UK, over 1.3 million people have a diagnosis of AF and an estimated 400,000 remain undiagnosed. AF-related strokes account for a quarter of all strokes and, as AF episodes are often asymptomatic, are still often the first manifestation of AF. Early diagnosis and initiation of oral anticoagulation, where appropriate, may prevent some of these thromboembolic strokes. Public Health England is committed to decrease the incidence of AF-related strokes and has sponsored initiatives aimed at improving AF detection by promoting the uptake of wearable technologies. However, the National Institute for Health and Care Excellence (NICE) has not recommended wearable technology in their recent AF diagnosis and management guidelines (NG196). Diagnostic accuracy of single-lead electrocardiography (ECG) generated by the latest iteration of wearable devices is excellent and, in many cases, superior to general practitioner interpretation of the 12-lead ECG. High-quality ECG from wearable devices that unequivocally shows AF can expedite AF detection. Otherwise, there is a real risk of delaying AF diagnosis with the potential of devastating consequences for patients and their families.

Keywords: NICE; atrial fibrillation; digital health technology; stroke prevention; wearables.

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Figures

Fig 1.
Fig 1.
Devices used for atrial fibrillation screening. AF = atrial fibrillation; PPG = photoplethysmography; RCTs = randomised controlled trials.
Fig 2.
Fig 2.
a) Photoplethysmography (PPG) relies on reflected light to measure blood volume changes in the microvasculature. b) A PPG wave form has a systolic and diastolic component and changes in both amplitude and period can identify heart rate irregularity. c) Examples of a 30-second PPG waveform recorded by the CART-I Ring (SkyLabs). PPG = photoplethysmography.
Fig 3.
Fig 3.
Sensitivity and specificity of 12-lead electrocardiography (ECG) interpreted by cardiologist and general practitioners (GPs; endorsed by National Institute for Health and Care Excellence (NICE) as gold standard) and single-lead ECG from wearable devices interpreted by an expert physician included in NICE Expert Review B (NG196).9
See this image and copyright information in PMC

References

    1. Public Health England . Public Health Profiles. Public Health England. https://fingertips.phe.org.uk/search/atrial
    1. Odutayo A, Wong CX, Hsiao AJ, et al. . Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ 2016;354:i4482. - PubMed
    1. Atrial fibrillation prevalence estimates for local populations. https://www.gov.uk/government/publications/atrial-fibrillation-prevalenc... [Last accessed 12 May 2015].
    1. NHS England . The NHS Long Term Plan. NHS, 2019. www.england.nhs.uk/long-term-plan [Accessed 11 May 2021].
    1. Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007;146:857–67. - PubMed

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