2023-09-19 14:18:20
Smartphones and technologies to prevent stroke. A group of researchers from the Policlinico Campus Bio-Medico in Rome evaluated whether the use of a series of devices that can be connected to the mobile phone, capable, for example, of monitoring the heart rate and measuring some vital parameters, could help to identify most effectively a possible cause of the stroke. In the study, conducted with the support of the Ania Foundation (National Association of Insurance Companies) and published in ‘Frontiers in Neurology’, early signs of atrial fibrillation, a cardiac arrhythmia causing stroke, were found, which made it possible to act immediately with the correct prevention therapy (an anticoagulant drug).
In Italy – a note recalls – a stroke occurs every three minutes and this pathology represents the third cause of death and the most frequent cause of permanent disability in adults. Many cases of stroke can be linked to often asymptomatic cardiac arrhythmias or recurrent hypertensive peaks, which are also asymptomatic. But a significant number of strokes apparently remain without a cause and in these cases it is very difficult to prescribe an effective therapy capable of preventing the recurrence of cerebral ischemia. The study evaluated the feasibility of using new technologies in the secondary prevention of cerebrovascular events in patients who had had a transient ischemic attack or TIA (transient ischemic attack) or a ‘minor stroke’ (cerebral ischemia with mild symptoms). 161 patients were recruited, 87 in the study group, 74 in the control group.
The patients were monitored for a month using a latest generation smartwatch capable of recording the electrocardiogram and devices that can be connected to the same smartwatch through which it is possible to measure blood pressure and blood oxygen saturation. These devices interacted via Bluetooth with a smartphone provided by the researchers on which the data collected during the month of observation was recorded. The patient was asked to wear the smartwatch as much as possible to continuously record various parameters, such as heart rate and variability, movement, steps, etc., and to measure blood pressure at least a couple of times a day, evaluation of oxygen saturation and recording of the electrocardiogram. This data was integrated with the classic clinical evaluation to have a more detailed and precise picture of the patient’s global health status and to be able to personalize therapeutic decisions. In the study group, 9 episodes of atrial fibrillation were identified compared to 3 identified in the control group.
“The number of atrial fibrillations found in the group of patients covered by the study is notable”, comments Vincenzo Di Lazzaro, full professor of neurology, director of the Neurology Unit at the Bio-Medico Campus and head of the study, observes. “Atrial fibrillation – he continues – is a silent killer because it is often asymptomatic, the patient may not notice until its catastrophic consequences appear which can lead to a cerebral embolism. Equally notable are the data collected on the measurement of blood pressure, which allow us to have a picture of the trend of blood pressure values in daily life. Collecting data in everyday life is essential for planning personalized prevention interventions. The use of new technologies opens up new scenarios for the prevention of cerebrovascular events, in “field of so-called precision medicine”.
This innovative approach is not only feasible and easy to apply, as can be seen from the excellent data on patient compliance and satisfaction – we read in the note – but it was also effective in improving the management of the phases following discharge from hospital. “The data present in the literature – underlines Fioravante Capone, neurologist at the Campus Bio-Medico Polyclinic and co-author of the study – tell us that after a stroke or a TIA there is a non-negligible risk of recurrence, that is, that the event may repeat itself in the subsequent period. This risk can be quantified in 15-20% of patients 5 years after the first event, especially in the phases immediately following TIA or stroke. It is significant to observe that, although the management of stroke in the acute phase has significantly improved – as demonstrated by the sharp decrease in mortality over the last two decades – the recurrence rate of cerebral ischemia has remained substantially unchanged, indicating that there is still much to be done in this regard. The set of interventions aimed at reducing the risk of relapse is what we mean by the term secondary prevention”.
“When the patient returns to his normal life the risk of recurrence is higher. We were looking for an approach that was not only effective – explains Francesco Motolese, neurologist at the Bio-Medico Campus and co-author of the study – but also easily implementable by all patients, regardless of age, digital literacy or education. These tools allow you to continuously and effortlessly monitor many physiological parameters or measure an actual electrocardiogram with a finger. With our study we verified whether this approach was applicable to stroke , a pathology that affects approximately 200 thousand Italians every year. The results confirm that new technologies can represent an added value in following these patients even outside the hospital environment and for prolonged periods.”
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