News in Brief: Apple Watch to keep time on arrhythmia; Target early-life cardiovascular risk factors; More precise risk stratification possible with Canadian TIA Score;

Wednesday, 17 Feb 2021

Apple Watch to keep time on arrhythmia

The TGA has approved the Irregular Rhythm Notification Feature for the Apple Watch.

The software-only mobile medical application analyses pulse rate data to identify episodes of arrhythmia suggestive of AF. It then provides a push notification to the user.

“Along with the user’s risk factors, the feature can be used to supplement the decision for AFib screening,” the TGA Public Summary document said.

But neither the TGA nor Apple can promise the feature is 100% reliable and it is not designed to replace traditional methods of diagnosis or treatment.

“It is not intended to provide a notification on every episode of irregular rhythm suggestive of AFib and the absence of a notification is not intended to indicate no disease process is present; rather the feature is intended to opportunistically surface a notification of possible AFib when sufficient data are available for analysis,” the TGA said.

Apple’s marketing said the irregular rhythm notification feature on the Apple Watch is not constantly looking for AFib.

“This means it cannot detect all instances of AFib, and people with AFib may not get a notification,” Apple said.

The TGA noted the data is only captured when the user is still, the feature was not intended for young people under 22 years, or people previously diagnosed with AFib.

Target early-life cardiovascular risk factors

Coronary atherosclerosis attributable to non–HDL-C begins early in life, according to a sub-study from the Cardiovascular Risk in Young Finns Study.

An analysis of 589 people with a follow-up of 28 years found higher non–HDL-C was evident at every observed age group in individuals who had evidence of coronary artery calcification (CAC) in mid-adulthood compared with individuals without CAC.

However the association was strongest in adolescence (12-18 years) than in young adulthood (21-30 years) or mid adulthood (33-45 years).

The study said relatively little attention was given to early-life cardiovascular risk factor levels.

“Altogether, early screening, identification, and management of elevated non–HDL-C levels may represent an important goal toward reducing the burden of heart disease in adulthood.”

Read more in JAMA Cardiology

More precise risk stratification possible with Canadian TIA Score

The Canadian TIA Score performs significantly better than the established ABCD2 and ABCD2i scores in stratifying risk of subsequent early stroke in patients presenting to ED with TIA or minor stroke.

A Canadian study of over 7,000 adults presenting to 13 EDs, found 1.4% had a subsequent stroke. The Canadian TIA score was able to effectively stratify patients into three pre-specified risk groups – low (<1% risk of stroke), medium (1-5%), and high (>5%).

In comparison the ABCD2 and ABCD2i scores were not able to classify any patients into the low risk group. Instead all but 3-7% of patients were bundled into the medium risk group.

The researchers said incorporating this now validated core into management plans should improve early decision making on hospital admission, timing of investigations, and specialist referral.

Read more in the BMJ


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