🎧 AF screening; sodium, potassium, BP, and CV outcomes; drug prices; and cardio-respiratory fitness are the topics John Mandrola, MD, covers in this week’s podcast.
centered on the question of whether to do AF screening in a 75-year-old man with hypertension and diabetes. One extremely accomplished professor argued for AF screening. One marginal podcast host argued against further AF screening.
The general idea of screening for disease comes up often on #TWICPodcast but these have always been about medically directed screening — stuff we do: monitors, colonoscopies, mammography, vascular screening etc. The unique thing that’s happening in AF screening now is that doctors are being shut out of the picture because of consumer devices, like smart watches. I am seeing more and more patients with screen-detected AF that came not from a medical-grade monitor, but a consumer device.
The primary outcome measure was the incremental cost effectiveness ratio . Ratios being fractions this was US dollars divided by quality-adjusted life years .They report that all six screening strategies using wrist worn devices were more effective than no screening.The screening model with the best QALY gain was a sequence of a wrist-worn wearable pulse monitor followed conditionally by wrist-worn wearable one-lead ECG and confirmatory patch monitor.
The overall most cost-effective strategy was wrist-worn wearable photoplethysmography followed conditionally by wrist-worn wearable one-lead ECG and confirmatory patch monitor .
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