Abstract
Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia, and ECG remains the gold standard for diagnosing AF. Wrist-worn technologies are appealing for their ability to passively process near-continuous pulse signals. The clinical application of wearable devices is controversial. Our systematic review and meta-analysis qualitatively and quantitatively analyze available literature on wrist-worn wearable devices (Apple Watch, Samsung, and KardiaBand) and their sensitivity and specificity in detecting AF compared to conventional methods. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, yielding nine studies (n = 1,581). Observational studies assessing the sensitivity and specificity of wrist-worn wearables in detecting AF in patients with and without a history of AF were included and analyzed using a fixed-effect model with an inverse-variance method. In patients with a history of AF, the overall sensitivity between device groups did not significantly differ (96.83%; P = 0.207). Specificity significantly differed between Apple, Samsung, and KardiaBand (99.61%, 81.13%, and 97.98%, respectively; P<0.001). The effect size for this analysis was highest in the Samsung device group. Two studies (n = 796) differentiated cohorts to assess device sensitivity in patients with known AF and device specificity in patients with normal sinus rhythm (NSR) (sensitivity: 96.02%; confidence intervals (CI) 93.85%-97.59% and specificity: 98.82%; CI:97.46%-99.57%). Wrist-worn wearable devices demonstrate promising results in detecting AF in patients with paroxysmal AF. However, more rigorous prospective data is needed to understand the limitations of these devices in regard to varying specificities which may lead to unintended downstream medical testing and costs.
Highlights
BackgroundAtrial fibrillation (AF) is the most commonly diagnosed arrhythmia in clinical practice [1]
More rigorous prospective data is needed to understand the limitations of these devices in regard to varying specificities which may lead to unintended downstream medical testing and costs
Our results indicate that the sensitivity was sustained across all three devices (Apple Watch sensitivity: 97.92, confidence intervals (CI): 96.09 to 99.74; KB sensitivity 96.94, CI 94.71 to 99.16; Samsung sensitivity 95.47, CI: 93.10 to 97.840)
Summary
BackgroundAtrial fibrillation (AF) is the most commonly diagnosed arrhythmia in clinical practice [1]. The consequences of AF, including thromboembolic events, stroke, and heart failure, are well documented. These consequences of disease progression account for the significant impact on morbidity, mortality, and healthcare costs [1]. The relationship between arrhythmia and stroke is perplexing; reports from the Framingham Study have demonstrated that the concomitant presentation of stroke with newly diagnosed AF suggests that cardiac emboli may be an important cause of stroke [3,4]. The temporal relationship between AF and stroke highlights the importance of prophylactic measures for stroke prevention [4]. Detection of both clinical and subclinical AF allows for early preventative measures, which would improve health outcomes
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