Abstract 10871: Income in Relation to Anxiety and Patient Engagement Among Stroke Survivors Using Smartwatches for Atrial Fibrillation Monitoring

Abstract

Background: Smartwatches are FDA-approved to detect atrial fibrillation (AF). We examined the associations between income level with anxiety, patient activation, and daily wear time in stroke survivors using smartwatches for AF detection. Methods: We analyzed data from the Pulsewatch study, a randomized controlled trial (NCT03761394) that enrolled participants aged ≥50 years with a history of stroke or transient ischemic attack, a CHA 2 DS 2 VASc risk score ≥ 2, and no contraindication to anticoagulation. Participants in the intervention group wore a cardiac patch monitor in addition to a smartwatch and smartphone for AF detection, whereas participants in the control group wore only the cardiac patch monitor. At baseline, 14 days, and 44 days, participants completed General Anxiety Disorder-7 and the Consumer Health Activation Index, which examined anxiety and patient activation, respectively . Adherence to the Pulsewatch system was measured by watch wear time. A longitudinal linear regression model was used to examine associations between baseline income (earning <$50K/yr. vs.≥$50K/yr.) and changes in anxiety, patient activation, and wear time over the study period. Results: A total of 95 participants were included in this study. Participants earning <$50K/yr. were 54.5% male and 90.9% white, while participants earning ≥$50K/yr. were 59.7% male and 88.7% white. At baseline, history of renal disease (12.1% vs 1.6%, 0.029), statin use (84.9% vs 96.8%, 0.034), depressive symptoms (65.6% vs 35.5%, 0.004), and anxiety symptoms (54.5% vs 18.3%, <0.001), were different between the income groups. The high-income group was associated with reduced anxiety and greater activation (β -2.60, p-value <0.001; β 7.83, p-value 0.005, respectively) but not significantly associated with wear-time (β 0.20, p-value 0.50) among stroke survivors. Conclusion: Stroke survivors with high baseline income had reduced anxiety and greater engagement when randomly assigned to smartwatch use for AF detection. Baseline income may influence stress levels and engagement associated with smartwatch use. Studies are needed to evaluate how the prescription of wearable devices affects mood and activation among older adults from diverse socioeconomic backgrounds.