Smartwatch enhances AF detection in patients at risk of stroke

The use of a smartwatch-based atrial fibrillation (AF) screening results in improved detection rates of new-onset AF relative to standard care in patients at increased risk of stroke, reports a study.

A total of 437 patients aged ≥65 years with elevated stroke risk (median age 75 years, 46.7 percent female, median CHA₂DS₂-VASc score 3.0) from two secondary care centres in the Netherlands were enrolled in this prospective multicentre randomized controlled trial (RCT).

Between November 2022 and December 2023, participants were randomly allocated in a 1:1 ratio to 6-month monitoring with a smartwatch with photoplethysmography and single-lead electrocardiogram (ECG) functions (intervention: n=219) or standard care (control: n=218).

An independent health team reviewed ECGs remotely within 24 h. New-onset AF, the primary outcome, was defined as a confirmed episode lasting ≥30 seconds on single-lead ECG or standard ECG methods.

New-onset AF was detected in 21 patients in the intervention group and in five in the control group (9.6 percent vs 2.3 percent; risk difference, 7.3 percentage points, 95 percent confidence interval [CI], 2.9‒11.7; p=0.001; hazard ratio, 4.40, 95 percent CI, 1.66‒11.66).

Furthermore, several episodes of asymptomatic AF were detected only in patients monitored with a smartwatch, while paroxysmal AF occurred in both groups.

“This RCT 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,” the researchers said. 

“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,” they added.