mHealth Wearable Devices Effective in Post-Cardiac Surgery Care

Wearable devices have shown to be extremely effective in monitoring high risk patients post heart surgery in a new study, pointing to the benefits of mHealth and remote patient monitoring.

Atrial fibrillation (AF), an irregular heartbeat that can increase the chance of stroke, was detected up to ten times more frequently in high risk patients who wore a continuous cardiac monitor for a month after heart surgery compared to patients who had standard follow-up care according to research presented today at the American Heart Association's Scientific Sessions 2020.

"The incidence of post-operative atrial fibrillation (POAF) after discharge from cardiac surgery is not well defined," said Subodh Verma, MD, PhD, a cardiac surgeon at St. Michael's Hospital, University of Toronto in Canada, and one of the lead authors of the study. "Most studies are limited to the hospitalization phase only; studies beyond hospitalization are few.”

“In addition, very little is known about patients who have little to no AF during hospitalization after cardiac surgery, and they are often sent home with no treatment,” Verma continued. “Therefore, the question of whether the risk of POAF extends after hospitalization remains an important and unanswered question, especially for patients who had no previous history of AF.”

The researchers followed 336 patients recovering from cardiac surgery at eight Canadian medical centers. None of the study’s participants had a history of atrial fibrillation prior to surgery and they were all at-risk for stroke based on factors such as their cardiac health, medical history, and age.

The participants were randomly assigned to two groups: 163 patients underwent 30 days of real time 24-hour cardiac rhythm monitoring through a wearable device on their chest, while the other  173 participants made up the control group and received 30 days of usual care without cardiac rhythm testing/electrocardiogram assessment unless it was deemed medically necessary.

Then, six to nine months after their surgery, the patients from both groups had 14 days of continuous cardiac rhythm monitoring.

The researchers found that in the patient group who wore the 24-hour monitoring patch, atrial fibrillation was detected at a rate 10 times higher than in those who received standard post-surgery care.

Atrial fibrillation or atrial flutter that lasted six minutes occurred and was detected in 32 (19.6 percent) patients from the remote patient monitoring group and in three (1.7 percent) patients who received usual post-surgery care during the 30 days they were followed.

"Our study points to the fact that POAF is not self-limited to hospital stay per se. A significant risk of POAF persists even in those patients without any preoperative or pre-discharge AF. These data may help inform physicians about the importance of surveillance and vigilance in patients at high risk of stroke with respect to monitoring and prompt treatment for AF," said Verma.

Earlier this year, The Texas Cardiac Arrhythmia Institute (TCAI) at St. David’s Medical Center in Austin recruited 40 patients for a pilot remote patient monitoring program that is testing how wearable devices can help providers create home-based care management programs.

“Digital monitoring allows us to better serve our patients by helping them follow prescribed plans, such as diet and exercise, to improve quality of life,” Andrea Natale, MD, FHRS, FACC, FESC, a cardiac electrophysiologist and TCAI’s executive medical director, said in a press release at the time of the mHealth program announcement. “Physicians can also receive alerts if patients experience abnormal heart rhythms, such as AFib.”

“Every participant is different, and the challenges they face are unique,” Natale continued. “For example, patients who are overweight are placed in nutrition and exercise programs, and their goal is to achieve at least a 10 percent decrease in body mass index. Digital health platforms can measure these changes.”