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Lankenau cardiologist examines rationale, design of heart study using smartwatches

Lankenau Medical Center September 18, 2018 Research News

Peter Kowey, MD, a cardiologist at Main Line Health's Lankenau Heart Institute (LHI), co-authored a new manuscript that examined the rationale and design of a large-scale, application-based study to identify cardiac arrhythmias using a smartwatch. He also served on the steering committee for the study.

The Apple Heart Study, a single-arm trial funded by Apple, Inc., ran from November 2017 through July 2018. The study enrolled 440,309 participants and is the largest screening for atrial fibrillation (AF) to date. Results of the Apple Heart Study are forthcoming. A recently published manuscript from Dr. Kowey and his colleagues explains the rationale for the study and the protocol design. The study “may form the framework on which future studies using wearable technology to detect AF will be based,” wrote the authors.

Identifying patients with AF is a critical task for health care providers, as the disorder is progressive and can markedly increase a patient’s risk of having a stroke. Previous studies in which Dr. Kowey has participated showed that continuous monitoring of an undiagnosed at-risk population that had been fitted with miniature implantable recording devices uncovered AF in nearly 40 percent of patients.

“The surprising results of previous studies have confirmed that we need to develop a large-scale, non-invasive method to monitor the general population, since AF symptoms can be silent or minor,” noted Dr. Kowey, the William Wikoff Smith Chair in Cardiovascular Research at Lankenau Institute for Medical Research, also part of Main Line Health. “If we can identify AF patients earlier in their disease progression, we may be able to treat symptoms and prevent stroke and heart failure, the two most catastrophic outcomes associated with AF.”

Smartwatches and other fitness bands (known as wearables) passively measure pulse rate at the wrist using photoplethysmography (PPG). Longitudinal pulse information can be analyzed via PPG in real-time to determine irregularity and variability.

Participants in the Apple Heart Study whose pulse data identified them as potentially having AF were notified of such through the mobile app and encouraged to contact the telemedicine technology services company that had partnered with the study. If AF was suspected or confirmed, participants received a conventional seven day patch monitor to confirm the diagnosis. Participants with urgent symptoms were directed to go to an urgent care center or an emergency room for medical evaluation.

“The unique features of this study are its very large scale and its completely virtual design,” said Dr. Kowey. “Patients were enrolled, gave consent and were monitored remotely, without a physician present. This enabled a significant number of participants to be recruited in a short amount of time.”

Importantly, he continued, private health information (PHI) was protected, and Apple did not have access to patients’ PHI.

The authors concluded the Apple Heart Study “will provide initial evaluation of the ability of a smartwatch algorithm to identify an irregular pulse consistent with previously unknown AF.”

The full manuscript, “Rationale and design of a large-scale app-based study to identify cardiac arrhythmias using a smartwatch: The Apple Heart Study” was published in American Heart Journal.

About Main Line Health

Founded in 1985,Main Line Health is a not-for-profit health system serving portions of Philadelphia and its western suburbs. Main Line Health’s commitment—to deliver advanced medicine to treat and cure disease while also playing an important role in prevention and disease management as well as training physicians and other health care providers—reflects our intent to keep our community and ourselves well ahead. A team of more than 10,000 employees and 2,000 physicians care for patients throughout the Main Line Health system.

At Main Line Health’s core are four of the region’s most respected acute care hospitals—Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital—as well as one of the nation’s recognized facilities for rehabilitative medicine, Bryn Mawr Rehabilitation Hospital.

Main Line Health also includes Mirmont Treatment Center for drug and alcohol recovery; Main Line Health HomeCare & Hospice, which includes skilled home health care, hospice and home infusion services; Main Line Health Centers, primary and specialty care, lab and radiology, and other outpatient services located in Broomall, Collegeville, Concordville, Exton, King of Prussia and Newtown Square; Lankenau Institute for Medical Research, a biomedical research organization; and Main Line HealthCare,one of the region’s largest multispecialty physician networks.

Main Line Health is the recipient of numerous awards for quality care and service, including System Magnet® designation, the nation’s highest distinction for nursing excellence and the Mid-Atlantic Alliance for Performance Excellence (MAAPE) Excellence Award. Main Line Health is committed to creating an environment of diversity, respect and inclusion and has proudly embraced the American Hospital Association’s #123forEquity Pledge to Act to eliminate disparities in care. We are dedicated to advancing patient-centered care, education and research to help our community stay healthy.

About Lankenau Heart Institute

The Lankenau Heart Institute is Main Line Health’s premier, comprehensive cardiovascular medicine and surgery program. The Lankenau Heart Institute brings together the clinical expertise of all four Main Line Health acute care hospitals and community cardiology practices to ensure that patients receive a level of quality, service, and experience that is unprecedented in the region. Through the system-wide coordination of services, the Lankenau Heart Institute delivers preventive, diagnostic, therapeutic, and rehabilitative cardiovascular services at each of our locations including Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital.

Lankenau Heart Institute continues to be a pioneer in the use of beating-heart techniques and robotic-assisted procedures for coronary artery revascularization, minimally invasive and transcatheter approaches for valve repair and replacement, and complex aortic surgeries. With our growing experience and focus on minimally invasive techniques, Lankenau Heart Institute has expanded participation in clinical trials year over year. Our physicians are frequently invited to participate in clinical/medical device trials, many of these designed to facilitate minimally invasive procedures/approaches.

With a collaborative team of expert consultative cardiologists, interventional cardiologists, electrophysiologists, cardiovascular surgeons and specially trained nurses and technologists, the Lankenau Heart Institute is dedicated to managing and treating patients with heart failure, aortic disease, coronary and peripheral vascular disease, heart rhythm disorders and valve disease. Our team of cardiologists and cardiac specialists provide patients and their families with expert cardiac care, close to home.

About Lankenau Institute for Medical Research

Lankenau Institute for Medical Research (LIMR) is a nonprofit biomedical research institute located on the campus of Lankenau Medical Center and is part of Main Line Health. Founded in 1927, LIMR’s mission is to improve human health and well-being. Faculty and staff are devoted to advancing innovative new approaches to formidable medical challenges, including cancer, cardiovascular disease, gastrointestinal disorders and autoimmune diseases, such as diabetes and arthritis. LIMR’s principal investigators conduct basic, preclinical and translational research, using their findings to explore ways to improve disease detection, diagnosis, treatment and prevention. They are committed to extending the boundaries of human health through technology transfer and training of the next generation of scientists and physicians.