Feasibility and diagnostic yield of a photoplethysmography-based arrhythmia screening and integrated management pathway in a COPD outpatient clinic

Abstract

Background and aims: Guidelines recommend opportunistic atrial fibrillation (AF) screening in high-risk populations, including COPD patients. This cohort study aimed to evaluate the feasibility and yield of a photoplethysmography (PPG)-based mHealth pathway for AF detection in a COPD outpatient clinic.

Methods: COPD patients at Maastricht University Medical Centre+ were invited to participate in a 14-day PPG-based AF screening embedded within the COPD care pathway using their smartphone.

Results: Out of 155 invited moderate-to-severe COPD patients, 99 (mean age 66±9 years, 54% female) participated in the AF screening. Adherence (101% (82-123%)) and patient satisfaction (System Usability Score 80.0 (IQR 55.0-92.5)) were high. The PPG-based pathway detected 8 of 99 (8.1%) AF cases (6 new and 2 known AF). Additional cardiac work-up of the six new cases revealed ECG-confirmed AF in two (2.0%) patients and frequent premature beats in three patients. PPG analysis showed additional arrhythmias in 95 of 99 patients (isolated premature beats) and 31 of 99 patients (frequent premature beats), of which 8 (8.0%) patients necessitated additional cardiac analysis. The overall diagnostic yield of PPG-based AF screening was thus 8%, yield of ECG-confirmed new AF was 2% and in 10% of the patients, additional arrhythmias were detected. Of the 99 patients, 12 of 99 (12%) patients needed referral to cardiac work-up.

Conclusion: 14-day opportunistic PPG-based, mHealth-supported AF screening is feasible in COPD outpatient care and results in the detection of new AF cases and premature beats. This novel digital approach offers a practical guidance for implementing recommended AF screening and management in COPD patients.

FIGURE 1

Remote photoplethysmography (PPG) app-based prolonged opportunistic arrhythmia screening pathway. CVD: cardiovascular disease; AF: atrial fibrillation; ABC: Avoid stroke with anticoagulation, Better symptom management through rate or rhythm control and Comorbidity and cardiovascular risk factor management.

FIGURE 2

Flowchart of the inclusion process.

FIGURE 3

Flowchart of the diagnostic transition to comprehensive cardiac follow-up of photoplethysmography (PPG) recordings with suspicious PPG results. Isolated premature beats (PMBs) are defined as <6·min⁻¹ and frequent premature beats are defined as ≥6·min⁻¹. The discrepancy in numbers between the total study population and the final count is a result of individuals who dropped out during the screening process. 12-L, 12-lead; 1-L, one-lead; AF: atrial fibrillation; PAT: paroxysmal atrial tachycardia; SVT: supraventricular tachycardia; DOAC: direct oral anticoagulant; CT: computed tomography; P: pending results. ^#: One patient who was given a handheld ECG device was lost to follow-up, and we do not have any electrocardiography (ECG) confirmation for this patient.

FIGURE 4

Examples of photoplethysmography (PPG) signals detected during a) sinus rhythm, b) frequent premature beats (≥6·min⁻¹) and c) atrial fibrillation.