The trial uses an Apple smartwatch to monitor episodes of AFib, a heart rhythm disorder that can lead to blood clots and strokes. If patients are able to go 30 days without an episode, they can discontinue the use of blood thinners – while remaining monitored by the watch. — Photo by Angus Gray on Unsplash
After multiple medical procedures starting in May 2022, Arthur Schiebel was pleased to have his atrial fibrillation under control. He was less pleased to find out he’d need to take blood thinners twice a day – likely for the rest of his life – to reduce the risk of having a stroke.
"I'm not used to taking all this stuff," he thought at the time. "I just want to get off all this medication."
Thanks to a clinical trial at Allegheny General Hospital, Schiebel, 73, has gotten his wish.
The trial uses an Apple smartwatch to monitor episodes of AFib, a heart rhythm disorder that can lead to blood clots and strokes. If patients are able to go 30 days without an episode, they can discontinue the use of blood thinners – while remaining monitored by the watch.
"This frankly wasn't possible five or 10 years ago," said Amit Thosani, director of cardiac electrophysiology at AHN. "It is now, with wearable and smartphone technology."
About 10 million people in the United States have AFib, the most common heart rhythm disorder. Many of those patients meet the criteria for an elevated risk of stroke and are told to take anticoagulant medications.
"We're talking about a huge number of people being prescribed blood thinners," said Thosani.
For those patients, there is not currently a metric for getting them off of those blood thinners, which have the downside of an increased risk of bleeding. Enter the five-year REACT-AF trial, led by Johns Hopkins University, which started in July 2023and is attempting to enroll 5,350 patients in about 100 different sites.
The study is made possible not only by advances in wearable technology, said Thosani, but also in improvements in medication. Blood thinner medications today are effective within hours, while in the past, they took up to a week to take effect. With that lag, there was less flexibility in going on and off of the medication, which may be required by the study.
AGH is currently the second-largest study site, with about 80 patients enrolled. Patients are divided into a control group, which continues to take blood thinners, and an experimental group, which can stop taking their anti-coagulant if the watch doesn't detect an abnormal rhythm lasting longer than an hour for 30 days.
One of those patients is Schiebel, of Jefferson Hills. In May 2022, he started to have some uncomfortable sensations. He thought it might be indigestion but asked his wife, a retired nurse, to listen to his heart with her stethoscope. She listened, didn't like what she heard, and told him to see his doctor – who sent him to the emergency room.
Scheibel was admitted for two days while the hospital tried to shock his heart back into rhythm through a procedure called a cardioversion. Another cardioversion followed a few months later, followed by a surgical procedure called an ablation, in September 2022, that eventually got the AFib under control.
At that point in his life, Scheibel took no daily medication other than a small cholesterol pill, and didn't like having to take a blood thinner called Eliquis twice a day.
When Thosani proposed the REACT-AF study as an option for him, he jumped at the opportunity. He enrolled, was selected for the experimental group, and cleared 30 days with no AFib earlier this year.
"I've been off Eliquis since February with no issues," he said. "I never wore a watch in my life but if this thing will keep me off the medication, I'm wearing it." – Pittsburgh Post-Gazette/Tribune News Service
