First in world implementation of a smartphone application in primary and secondary prevention of stroke

Abstract

With an ageing population, the burden of atrial fibrillation (AF) and its complication of stroke continues to rise. Current screening strategies are hampered by large expenses, dedicated equipment, time investment, logistics, and medical personnel. This work introduces FibriCheck as new screening tool for the detection of AF and prevention of stroke. (1) In a systematic screening programme, FibriCheck was able to detect previously undiagnosed AF in 0.8% of the general population with 100% sensitivity, 97% specificity and 97% accuracy. (2) A nine-day completely digital mass screening programme included 12,328 participants, who on-boarded within 48 hours. 136 AF-patients (1.1%) were identified. 81 AF-cases (60%) were confirmed following consultation of a physician. (3) The diagnostic yield of the application as a long-term monitoring device in high risk patients was evaluated. AF was identified in 13%, including 5% previously undiagnosed. Compared with usual care, 10% would have received prolonged monitoring as part of the planned care-path. (4) A Markov model indicated 26 quality adjusted life years (QALY) and substantial cost savings of €1.189 per QALY gained when implementing the application in a population of 1000 stroke patients. To conclude, FibriCheck proved to be an accurate and reliable means to detect AF in unselected and selected populations in a cost-effective way.