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How Can Seniors Check for AFib at Home?

Mom went to the emergency room with a severely racing heart. Nurses attached 12 electrodes to her chest, arms, and legs. They ran the electrocardiogram (ECG). The doctor diagnosed her with atrial fibrillation (AFib, because “AF” stands for “Atrial Flutter”). They got her heart rate down, and sent her home. She cannot tell if the flutters she feels now are anxiety or more AFib’s. She is worried she is having another attack. However, she has worried that if her events are nothing, that she will waste money and time on more hospital visits.

For mom to  check her AFib at home, she should get an over-the-counter atrial fibrillation electrocardiogram (ECG), or a “home heart monitor” She can check her symptoms at home, and send her doctor the ECG too. She uses the device with caution, though, because home ECG monitors are not as accurate as hospital ECG’s. If she has symptoms that need attention, she gets help whether the monitor picks up the AFib or not. If the monitor warns of an event but she is not sure, she takes a few readings to re-check her heart rhythm.

ViAtom Heart Monitor
ViAtom Heart Monitor

The best AFib monitors allow users to send results to their doctors. All of them give results within 30 seconds to 2 minutes.

Want to cut to the chase? Click here to read about the best home ECG for monitoring atrial fibrillation.

Check out the best home heart rate monitors: Best Heart Monitor for Mom to Check AFib at Home

Do Home Monitors Diagnose AFib?

Home ECG devices cannot diagnose any disease. They do not provide enough data. At the hospital, cardiology specialists control data collection. They can correct for bad inputs such as patient sweating and trembling. They use 12-lead ECG’s, while home ECG’s use only one lead. The home AFib monitor’s role is to warn of a possible event. Only trained medical staff can diagnose an arrhythmia.

What are the Differences Between Home and Hospital AFib Monitors?

Both hospital and home ECG’s record and report on heart rhythms. Hospital ECG’s use 12 electrical leads placed on the arms, legs and chest. Home AFib ECG’s use one lead the user holds in her hands. Hospital ECG’s record and analyze electrical activity. Home ECG’s record and analyze pulse activity. Cardiologists use 12-lead ECG’s to determine where the problem is located. Home ECG’s do not gather enough data to include location.

What is Pulse-Taking AFib Detection?

Home AFib devices use two points of contact to gather the user’s pulse information. They derive the heart rate pattern from the pulse pattern. You might see this technology referred to as “Photoplethysmographic” or PPG.

Researchers have studied PPG effectiveness in catching AFib. They now recommend home AFib monitors as a cost-effective way to find AFib cases.

The Science Behind Pulse AFib Detection

Researchers used the Cardiio Rhythm AFib monitor on 1,013 subjects. The device accurately found AFib in 92.9%, and accurately excluded AFib from 97.7%. The AliveCor ECG accurately found AFib in 71.4%, and accurately excluded AFib from 99.4%.

Another study found the AliveCor accurately found AFib in 98% of 204 subjects, and accurately excluded AFib in 97% of subjects.

Researchers tested if pharmacists could help screen the community for AFib. They tested 1,000 patients. The Alivecor technology correctly assessed AFib 98.5% of the time, and accurately excluded AFib 91.4% of the time.

Researchers tested AliveCor and MyDiagnostik technology on 113 geriatric ward patients. AliveCor correctly found 78.9% of the AFib cases, and correctly excluded 97.9% of the non-AFib cases. MyDiagnostik correctly found 89.5%, and correctly excluded 95.7%. MyDiagnostik uses PPG technology but is not an over-the-counter device available to the public.

Do Home AFib Devices Warn of Heart Attacks?

No! Home AFib devices do not warn of heart attacks!

Home AFib monitors are programmed to detect irregular electrical patterns known as arrhythmias. Arrhythmias are irregular heartbeats. A heart attack is when blood flow to the heart becomes blocked.

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Monitors as Safety Nets

Patients have to spend money and time on 12-lead hospital ECG’s. AFib’s do not always occur during these tests. So home monitoring makes sense. Patients can use it to catch AFib events when they are not getting a hospital test.

To catch elusive events, cardiologists sometimes send patients home with heart monitoring devices. Either the patient wears a Holter Monitor, or the doctor injects a monitor under the skin. Cardiologists can then gather more data in an effort to capture an event.

In one study, researchers implanted cardio monitors in 446 patients with suspected atrial fibrillation. At 18 months, the monitors caught AFib in 29.3% of the patients. At 30 months, they had caught AFib in 40% of the patients.

The authors said that these patients were at a high risk for atrial fibrillation and stroke. The implantable monitors allowed the doctors to finally diagnose and treat the elusive AFib events. The stroke-prevention study was reported in the April, 2019 issue of JAMA Cardiology
Check out the best home heart rate monitors: Best Heart Monitor for Mom to Check AFib at Home

Can Single-Lead ECG’s Catch Elusive AFib Events?

Over-the-counter ECG’s collect much less data than hospital 12-lead ECG’s. Are these small devices even worth using?

Some cardiology researchers are using single-lead ECG’s in the field. They are screening for AFib using consumer devices.

In poor and remote areas, the choice can boil down to using a consumer ECG, or nothing at all. Since AFib screening prevents strokes, some researchers decided to screen using a consumer device. None of these studies compared their single-lead tests with a 12-lead ECG. What is interesting is the faith the researchers had in the consumer devices.

BMJ (British Medical Journal) researchers used the Firstbeat Bodyguard to screen for AFib. They found atrial fibrillation in a remote population that had no access to hospital equipment. The authors concluded that comprehensive remote screening for AFib could prevent 12% of all strokes.

In another study, researchers visited a poor area with scarce medical services. They tested 50 subjects with the KardiaMobile ECG, and found AFib in four of them. The case was described in December, 2017 issue of Global Heart.

Researchers in China found AFib in 1.8% of the 2,001 people they studied. They used the AliveCor KardiaMobile. This was reported in the March, 2015 issue of the Journal of the American College of Cardiology.

Can You Use a Home AFib Monitor to Decide When to Take Medication?

I see reports in forums and product reviews of people basing their medication times on their consumer-level ECG reports. I am not a doctor, but I am not afraid to say that there is no way this is a safe practice.

Only your doctor can tell you if you should ever skip or delay a medication dose. Even if changing medicine doses made sense, you would not base that on a one-lead ECG.

What if you get a false negative? Alternatively, maybe your medication does not work if it is taken in fits and starts.

If you were advised to alter medication behavior based on ECG data, I would expect that you would get that data from a Holter or implantable ECG, at a minimum.

This seems like a terrible idea:

“[M]y afib was spinning out of control. When I would go into afib I wanted confirmation that I was indeed in afib so I knew I could safely take my Flecainide. I would then use it a few hours later to confirm that I converted to normal sinus rhythm (NSR).”

What are the Downsides of Using a Home AFib Monitor?

Consumer ECG’s should not be used to detect heart attacks, blood pressure, or clogged arteries. Do not expect an ECG to report your cholesterol levels.

Wired Magazine, the Washington Post, and an alleged doctor on Youtube make the following arguments against using a home device to check for AFib:

  • Consumer ECG’s will raise anxiety in healthy individuals who get false positive AFib readings.
  • Home ECG tests will lead to unnecessary, invasive and expensive medical tests.
  • Low risk populations will be wasting money to buy home ECG monitors.

Check out the best home heart rate monitors: Best Heart Monitor for Mom to Check AFib at Home

Debunking the Anxiety, Wasteful Tests and Money Arguments

John is at low-risk for AFib, with the possible exception of his family history. His parents, two aunts, and one uncle, all died from atrial fibrillation. John is in a low-risk population, but he is worried he has AFib.

John can do nothing. Alternatively, he can ask his doctor for a 12-lead ECG to rule out AFib. Alternatively, he can buy an over-the-counter ECG to monitor for AFib at home.

The concern is that patients using home AFib monitors might get false positives. Then they will worry, and unnecessarily use hospital resources.

People who are extreme worriers are going to worry when they feel funny, when they feel fine, when their device shows AFib, and when their device does not show AFib.

Doctors do not base medical decisions on home AFib monitors. With or without AFib monitors, patients are going to ask for tests. Doctors can agree or disagree, based on all available data, not just the AFib results.

Did the AFib monitor get the result more than once? Is the patient at risk? Is the patient’s pulse irregular?

Patients cannot use extra hospital resources unless doctors order the tests. Doctors have access to all of the data they had before AFib monitors were invented. AFib monitors can and do warn of real events. Acting on that data can and does prevent strokes.

The Safety Net Scenario: John buys a home AFib monitor. It reports “Possible AFib.” John emails his ECG to his doctor. The doctor emails the ECG to a cardiologist. The cardiologists ask John to have a 12-lead ECG. The new ECG confirms the AFib. The cardiologist treats John’s AFib. The home monitor acted as a net that caught an AFib that otherwise never would have been caught. John does not have a stroke. His AFib does not kill him.

Worriers are going to worry. They are going to push their doctors for tests. They are going to spend money and use resources. They will do this with or without a home ECG to detect AFib.

Home monitors will report false positives and false negatives. Home monitors have limitations. Use them with your eyes open. Have reasonable discussions with your doctor. Test the device. See if you get the same result three times in a row.

A home monitor is a safety net. While it is catching a ton of AFib and preventing strokes right and left, it is also going to make mistakes. If it says “Possible AFib,” test again. If it says “Normal,” test again. Ask others to test your device. Accept that your monitor has limitations. Doctors should not hand out 12-lead ECG’s because a home device says to, or because a patient is anxious. If there is a good reason to test, the doctor should test. If there is no good reason to test, it is the patient’s responsibility to calm down.

The Washington Post’s Readers Know About AFib

The Washington Post argued that home AFib monitors would raise anxiety and waste resources. I disagree, and so do many of their readers.

The Post claimed that doctors would do expensive procedures based on unprofessional (home monitor) data. This is absolutely ridiculous. The monitor is not the doctor’s tool. It’s the patient’s tool. YOU use it to decide if you want to call the doctor or not. The doctor doesn’t use it to determine what tests to run on you. The doctor uses the same hospital tests used whether you own a home monitor or not.

You can have high anxiety without a monitor. Every flutter might be a heart attack. Do you call the doctor? Do you go to the hospital?

A monitor allows you to stop guessing. It allows you to make an informed decision about what to do next.

If you have concerns or symptoms, you can take a measurement. You’re getting a second opinion without bothering your doctor.

You can always call your doctor’s office for guidance.

Below are some responses from article readers who disagreed with the assertion that a monitor will lead to more tests or anxiety.

“This is ridiculous clickbait. NO WAY would any actual competent physician do catheterization without the OTHER, obvious precursor tests. Lies.”

 

“Soon after I started wearing it there was a conversation with my MD that led to a lot of tests, which, as it turns out, were necessary and which have led to an improvement in my health. Apple can sell me anything.”

 

“Overall, the Apple Watch has been hugely beneficial to millions. It persuaded me to get fitter, loose 73lbs and turn my health around – so while some of you sit on the sofa wondering what its all for, try using it. It might well save someones life, even one, and it’s worth it. No doctor is going to object to people being more aware of their health and their issues. Some family somewhere will be glad their mum or dad is still alive because of it…”

Check out the best home heart rate monitors: Best Heart Monitor for Mom to Check AFib at Home

” What a load of hooey. Any cardiologist worth his/her salt is not going to order a catheterization based on data from an Apple Watch.”

 

“Watch data, on the other hand, can provide an opportunity to discuss potentially dangerous hearth rhythms with one’s physician. Together, they can discuss a reasonable coarse of action, including no action at all.”

 

“Now, will the Watch report false positives? That’s almost a certainty. An MRI can report a false positive, and it’s a million dollar device. Will the Watch report good data that could indicate a potential disorder, or an event, of which the user is unaware. That’s almost a certainty as well.”

How to Buy the Best AFib Monitor for Home Use

Check out the best home heart rate monitors: Best Heart Monitor for Mom to Check AFib at Home

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