Mobile health gadgets cost-effective for preventing stroke in high-risk patients

Using mobile health (mHealth) devices to screen for atrial fibrillation (AF) comes with steep upfront costs but can reduce the incidence of stroke, according to a recent study. Such technology bears more benefit for high-risk patients, as defined by the CHA₂DS₂-VASc* score.

“This study shows that mHealth devices are a recommendable tool to screen for AF in patients with high CHA₂DS₂-VASc scores. The higher the risk for stroke in patients with AF, the more cost-effective are the devices,” the researchers said.

The Monte Carlo simulation model included 30,000 patients for each CHA₂DS₂-VASc score and was constructed to estimate the cost burden of AF with and without the use of mHealth devices. Patients with higher risk score tended to accrue greater average costs over the whole duration of the simulation. [JMIR Mhealth Uhealth 2020;8:e20496]

Notably, the use of mHealth devices also increased the overall costs incurred by each patient.

However, on a per-event basis, the costs were decreasing in general. In patients with high CHA₂DS₂-VASc risk scores, the costs posed by the mHealth devices were lower than in those who were of lower risk. Electrocardiography (ECG) confirmation rate further intensified this effect, such that costs in high-risk patients were lower at better confirmation.

In patients with low CHA₂DS₂-VASc scores, the researchers explained, “the underlying basic risk for stroke is low. Thus, the risk reduction by use of mHealth devices is low as well.”

The use of mHealth devices could prevent strokes, though to varying degrees of efficacy. At lower risk levels, for instance, the avoided incidents were low in number, while in higher-risk patients, hundreds of stroke episodes could be averted. The chance of preventing strokes was driven mainly by two factors: CHA₂DS₂-VASc risk score and the ECG confirmation rate.  

A higher risk score leads to a greater incidence probability of AF, the researchers explained, which would mean a higher detection rate when screening using the mHealth devices. This would encourage anticoagulant initiation which, in turn, would suppress stroke prevalence.

On the other hand, high ECG confirmation rate, as a function of the device’s predictive value, meant that more AF cases would be detected and subsequently treated, thereby preventing stroke development.

Notably, no clear effects on stroke prevention were seen in lower-risk patients in both the cases of CHA₂DS₂-VASc risk score and ECG confirmation rate.

“From an economic point of view, the use of these devices in patients with high risk scores increases the costs per patient. With higher risk scores, costs per prevented stroke decrease. Higher device accuracy leads to more stable results,” the researchers said.

“From a patient-oriented perspective, the use of mHealth devices results in reduced number of strokes. More strokes can be prevented if the underlying CHA₂DS₂-VASc score is higher. In addition, a high ECG confirmation rate and increased device accuracy lead to more prevented strokes,” they added.

*Congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category