Atrial fibrillation (AF) is an increasingly common phenomenon amongst elderly patients, particularly those with diabetes, heart disease and hypertension. It increases the risk of stroke and other embolic phenomenon significantly but with modern anticoagulants its management has become much easier.
Intermittent AF is also common when infection or other illness strikes the patient. It can also occur randomly in many people. Such paroxysmal atrial fibrillation (PAF) is less likely to cause embolic disease but remains a significant risk for some patients.
Tremendous advances in medical technology are occurring on many fronts. For consumers smart devices are increasingly common and best represented by the newest generation of the Apple watch which can monitor pulse rate and rhythm with high degree of accuracy.
Many patients with AF are unaware of their condition. Alerted by these new monitoring devices many will be presenting to their GPs for professional advice. While managing this three-way interface is a new challenge the best guide for treatment at this time is the CHA2DS2-VASc score.
The algorithm for the smart watch is proprietary, meaning nobody outside the company knows how it works. This is a common feature for most medical devices, including personal implantable devices like pacemakers/defibrillators and insulin pumps. They are tested in clinical trials, as is the Apple watch, but the underlying mechanisms are unknown.
Medical authorities are apparently not concerned by this approach but some computer enthusiasts familiar with the failure of proprietary software applications in other areas prefer to trust their own expertise and advocate for the algorithms to be open and subject to peer review.
Some enthusiasts have built their own artificial pancreases. These reportedly give better glucose control than the commercial offerings but most have not undergone scientific trials.
For those who do not need implantable devices there are literally tens of thousands of medical applications available for the smartphone. Many patients are keen on these apps and may seek advice from their GPs. Unfortunately, few GPs have the time or the expertise to make their own assessments.
In an effort to help, the North Coast Primary Health Network has teamed up with Healthcare Software to collect, evaluate and publish these evaluations. Healthcare Software’s Digital Health Guide is a subscription service giving users information about an application, its intended audience, its pricing and which mobile platforms are supported.
Most importantly it is building up a database of the evidence behind each of the apps and how both users and health providers rate the application. The value of this data will build up overtime.
In our data intense world it could prove an invaluable resource for the modern day cyborg.