Skip to main content

Advertisement

Log in

Abstract

Atrial fibrillation (AF) is a multifaceted and highly variable disease that is often difficult to manage within the traditional health-care model. The conventional model of regular or pre-scheduled appointments with physicians or allied health professionals is poorly suited to the unpredictable and often urgent clinical needs of patients with AF. Mobile health (mHealth) has the potential to dramatically transform the delivery and quality of AF care. In this brief review, we summarize the current limitations and evidence gaps in treating patients with AF. We then describe the current mHealth landscape, changes in telehealth coverage and reimbursement, and recent technological advances of smartphones, mobile applications, and connected wearable devices. We also describe important barriers and challenges, such as clinical management of large volumes of data, application of predictive analytics/machine learning, and the need for high-quality randomized clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Turakhia MP, Hoang DD, Xu X, Frayne S, Schmitt S, Yang F, et al. Differences and trends in stroke prevention anticoagulation in primary care vs cardiology specialty management of new atrial fibrillation: the Retrospective Evaluation and Assessment of Therapies in AF (TREAT-AF) study. Am Heart J. 2013;165(1):93–101. e101.

    Article  PubMed  Google Scholar 

  2. Shore S, Carey EP, Turakhia MP, Jackevicius CA, Cunningham F, Pilote L, et al. Adherence to dabigatran therapy and longitudinal patient outcomes: insights from the Veterans Health Administration. Am Heart J. 2014;167(6):810–7.

    Article  CAS  PubMed  Google Scholar 

  3. Shore S, Ho PM, Lambert-Kerzner A, Glorioso TJ, Carey EP, Cunningham F, et al. Site-level variation in and practices associated with dabigatran adherence. JAMA. 2015;313(14):1443–50.

    Article  CAS  PubMed  Google Scholar 

  4. Turakhia MP, Ullal AJ. US health care policy and reform: implications for cardiac electrophysiology. J Interv Card Electrophysiol. 2013;36(2):129–36.

    Article  PubMed  Google Scholar 

  5. Pew Research Center, April, 2015, The smartphone difference. http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/.

  6. Fox, S. (February 1, 2011). Pew Research Center’s Internet & American life project—health topics. http://pewinternet.org/Reports/2011/HealthTopics.aspx.

  7. Carol E. Torgan, P. D. (November 6, 2009.). The mHealth summit: local & global converge. http://caroltorgan.com/mhealth-summit/.

  8. Chow CK, Redfern J, Hillis GS, Thakkar J, Santo K, Hackett ML, et al. Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: a randomized clinical trial. JAMA. 2015;314(12):1255–63.

    Article  CAS  PubMed  Google Scholar 

  9. Digital health funding: 2015 year in review. http://rockhealth.com/reports/digital-health-funding-2015-year-in-review/.

  10. Geneva Healthcare. Revolutionizing cardiac device data management. http://www.genevahealthcare.com/. Accessed February 2, 2016.

  11. Mittal S, Movsowitz C, Steinberg JS. Ambulatory external electrocardiographic monitoring: focus on atrial fibrillation. J Am Coll Cardiol. 2011;58(17):1741–9.

    Article  PubMed  Google Scholar 

  12. Turakhia MP, Hoang DD, Zimetbaum P, Miller JD, Froelicher VF, Kumar UN, et al. Diagnostic utility of a novel leadless arrhythmia monitoring device. Am J Cardiol. 2013;112(4):520–4.

    Article  PubMed  Google Scholar 

  13. Barrett PM, Komatireddy R, Haaser S, Topol S, Sheard J, Encinas J, et al. Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring. Am J Med. 2014;127(1):95 e11–97.

    Article  PubMed  Google Scholar 

  14. Qardio—state of the heart technology. https://www.getqardio.com/. Accessed March 10, 2016.

  15. AliveCor love your heart. http://www.alivecor.com/. Accessed March 9, 2016.

  16. Turakhia MP, Shafrin J, Bognar K, Goldman DP, Mendys PM, Abdulsattar Y, et al. Economic burden of undiagnosed nonvalvular atrial fibrillation in the United States. Am J Cardiol. 2015;116(5):733–9.

    Article  PubMed  Google Scholar 

  17. Svennberg, E., Engdahl, J., Al-Khalili, F., Friberg, L., Frykman, V., & Rosenqvist, M. (2015). Mass screening for untreated atrial fibrillation: The STROKESTOP Study. Circulation, doi:10.1161/CIRCULATIONAHA.114.014343.

  18. Lowres N, Neubeck L, Salkeld G, Krass I, McLachlan AJ, Redfern J, et al. Feasibility and cost-effectiveness of stroke prevention through community screening for atrial fibrillation using iPhone ECG in pharmacies. The SEARCH-AF study. Thromb Haemost. 2014;111(6):1167–76.

    Article  CAS  PubMed  Google Scholar 

  19. Chyou, J. Y., Hunter, T. D., Mollenkopf, S. A., Turakhia, M. P., & Reynolds, M. R. (2015). Individual and combined risk factors for incident atrial fibrillation and incident stroke: an analysis of 3 million at-risk US patients. J Am Heart Assoc, 4(7), doi:10.1161/JAHA.114.001723.

  20. Steven R. Steinhubl, M., Rajesh R. Mehta, R., Gail S. Ebner, B., Marissa M. Ballesteros, B., MBA, MPH, Waalena, J., Gregory Steinberg, M., BCh, et al. (2016). Rationale and design of a home-based trial using wearable sensors to detect asymptomatic atrial fibrillation in a targeted population: the mHealth screening to prevent strokes (mSToPS) trial. American Heart Journal.

  21. Turakhia MP, Ullal AJ, Hoang DD, Than CT, Miller JD, Friday KJ, et al. Feasibility of extended ambulatory electrocardiogram monitoring to identify silent atrial fibrillation in high-risk patients: the Screening Study for Undiagnosed Atrial Fibrillation (STUDY-AF). Clin Cardiol. 2015;38(5):285–92.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Passman, R., Leong-Sit, P., Andrei, A. C., Huskin, A., Tomson, T. T., Bernstein, R., et al. (2015). Targeted anticoagulation for atrial fibrillation guided by continuous rhythm assessment with an insertable cardiac monitor: the Rhythm Evaluation for Anticoagulation with Continuous Monitoring (REACT.COM) Pilot Study. J Cardiovasc Electrophysiol, doi:10.1111/jce.12864.

  23. Turakhia, M. P., & Estes, N. A., 3rd (2015). Stroke risk stratification in atrial fibrillation: bridging the evidence gaps. J Cardiovasc Electrophysiol, doi:10.1111/jce.12891.

  24. Keach JW, Bradley SM, Turakhia MP, Maddox TM. Early detection of occult atrial fibrillation and stroke prevention. Heart. 2015;101(14):1097–102.

    Article  CAS  PubMed  Google Scholar 

  25. McManus DD, Lee J, Maitas O, Esa N, Pidikiti R, Carlucci A, et al. A novel application for the detection of an irregular pulse using an iPhone 4S in patients with atrial fibrillation. Heart Rhythm. 2013;10(3):315–9.

    Article  PubMed  Google Scholar 

  26. Ho PM, Lambert-Kerzner A, Carey EP, Fahdi IE, Bryson CL, Melnyk SD, et al. Multifaceted intervention to improve medication adherence and secondary prevention measures after acute coronary syndrome hospital discharge: a randomized clinical trial. JAMA Intern Med. 2014;174(2):186–93.

    Article  PubMed  Google Scholar 

  27. Patel N, Chung EH, Mounsey JP, Schwartz JD, Pursell I, Gehi AK. Effectiveness of atrial fibrillation monitor characteristics to predict severity of symptoms of atrial fibrillation. Am J Cardiol. 2014;113(10):1674–8.

    Article  PubMed  Google Scholar 

  28. Lowes, R. (December 17, 2014). EHR meaningful use penalty will hit 257,000 clinicians in 2015. http://www.medscape.com/viewarticle/836824.

  29. Hodge Jr JG, Weidenaar K, Baker-White A, Barraza L, Bauerly BC, Corbett A, et al. Legal innovations to advance a culture of health. J Law Med Ethics. 2015;43(4):904–12.

    PubMed  Google Scholar 

  30. Revisor of Statutes, S. o. M. (2015). 62A.672 Coverage of telemedicine services. https://www.revisor.leg.state.mn.us/statutes/?id=62A.672.

  31. Basu S, Phillips RS, Bitton A, Song Z, Landon BE. Medicare chronic care management payments and financial returns to primary care practices: a modeling study. Ann Intern Med. 2015;163(8):580–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mintu P. Turakhia.

Ethics declarations

Disclosures

None

Disclaimer

The content and opinions expressed are solely the responsibility of the authors and do not necessarily represent the views or policies of the Department of Veterans Affairs.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Turakhia, M.P., Kaiser, D.W. Transforming the care of atrial fibrillation with mobile health. J Interv Card Electrophysiol 47, 45–50 (2016). https://doi.org/10.1007/s10840-016-0136-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-016-0136-3

Keywords

Navigation