BACKGROUND: Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major cause of stroke and often remains undiagnosed due to its paroxysmal and frequently asymptomatic nature. Wearables provide a scalable, noninvasive screening tool.
OBJECTIVES: This trial evaluated new onset AF detection in patients at elevated stroke risk using remote smartwatch-based screening.
METHODS: This prospective multicenter randomized controlled trial included patients =65 years with elevated stroke risk (CHA2DS2-VASc =2 men, =3 women) from 2 secondary care centers in the Netherlands. Patients were randomized to 6-month (180-day) monitoring with a smartwatch with photoplethysmography and single-lead electrocardiogram (ECG) functions, or standard care. ECGs were reviewed remotely by an independent eHealth team within 24 hours. The primary outcome was new onset AF, defined as a confirmed episode lasting =30 seconds on single-lead ECG or standard ECG methods.
RESULTS: Between November 2022 and December 2023, 437 patients were randomized (219 intervention, 218 control); the median age was 75 years, 46.7% were female and the median CHA2DS2-VASc score was 3.0. New onset AF occurred in 21 (9.6%) patients of the intervention group and 5 (2.3%) patients of the control group (risk difference: 7.3 percentage points; 95% CI: 2.9-11.7 percentage points; P = 0.001; HR: 4.40; 95% CI: 1.66-11.66). Several asymptomatic AF episodes were detected only in the intervention group, while paroxysmal AF occurred in both groups.
CONCLUSIONS: This randomized controlled trial provides evidence that 6-month smartwatch-based AF screening enhances the detection rate of new onset AF compared with standard care in patients at elevated stroke risk. (Detection and Quantification of Atrial Fibrillation in High-risk Patients Using a Smartwatch Wearable [Apple Watch] [EQUAL]; NCT05686330).
| Discipline Area | Score |
|---|---|
| Public Health |  |
| Family Medicine (FM)/General Practice (GP) | |
| General Internal Medicine-Primary Care(US) | |
| Internal Medicine |  |
| Geriatrics | |
| Cardiology | |
| Neurology | Coming Soon... |
The smart watch detected asymptomatic atrial fibrillation in those at increased stroke risk. Left unanswered is whether this information lead to interventions that decreased stroke and other ischemic events in the intervention group.
Interesting study but unclear why CHADs-VASc score was used to determine high-risk status when participants were not yet diagnosed as having Afib.
This article provides good evidence for using common wearable devices to increase the diagnosis of Afib. The trials mentioned in this article that assessed the clinical impact of this early diagnosis and treatment will be critical to determine whether there is clinical benefit (or harm) from early diagnosis using these devices.
Most of us know that wearables detect AF. What we still don’t know is whether picking up asymptomatic brief runs of AF helps patients.
Important data. The next step is to see whether outcomes are changed because of the knowledge gained.
Promising findings that common wearable devices (watches) can diagnose atrial fibrillation. Additional studies would be helpful due to some imbalances in baseline characteristics, particularly relevant co-morbidities.
These results on the use of technology to screen for new onset atrial fibrillation among elderly women aged 75 years or more were beneficial with the premise of adequate health insurance coverage for this Public Health problem. I am not sure of the clinical homogeneity of the statistically significant probability obtained (p=0.001). Nonetheless, I would recommend using Apple watches for the primary screening of new onset atrial fibrillation among all adults aged 19 years or more if their health insurance coverage is adequate for specialised cardiology services upon detection.
