JMIR Publications

ABSTRACT

Background:

Atrial fibrillation (AF), the most common cardiac arrhythmia, is often undiagnosed due to lack of awareness and frequent asymptomatic presentation. As AF is associated with increased risk of stroke, early detection is clinically relevant. Several consumer wearable devices (CWDs) are cleared by the US Food and Drug Administration for irregular heart rhythm detection suggestive of AF. However, there remains a lack of recommendations on use of CWDs for AF detection in clinical practice, especially with regard to pathways for workflow and clinical decisions.

Objective:

Our objective was to conduct a targeted literature review to identify articles on CWDs that characterize the current state of wearable technology for AF detection; identify approaches to implementing CWDs into the clinical workflow; and characterize healthcare provider and patient perspectives on CWDs for patients at risk of AF.

Methods:

Searches were conducted in PubMed, ClinicalTrials.gov, UpToDate Clinical Reference, and DynaMed for articles in English published between 2016 and 2021. The searches used pre-defined Medical Subject Headings, key words, and search strings. Articles of interest were specifically on CWDs; articles on ambulatory monitoring tools, tools available by prescription, or handheld devices were excluded. Search results were reviewed for relevancy and discussed among the authors for inclusion; data collected and extracted from the included articles were reviewed for themes relevant to addressing our study objectives.

Results:

A total of 20 articles met the inclusion criteria, including four medical society reports/guidelines; three general reviews; three systematic reviews; four healthcare provider surveys; three consumer/patient surveys; and three analytical reports. Despite recognition of CWDs by medical societies, the availability of detailed guidelines for use of CWDs for AF detection is limited, as was the availability of clinical tools such as care pathways. A main theme was the lack of pragmatic studies assessing real-world applications of CWDs for AF detection. Clinicians expressed concerns with data overload, the potential for false positives, and the need for clinical tools such as care pathways and guidelines, preferably developed and/or endorsed by professional organizations. Patient-facing challenges included costs of devices and the variability of digital literacy/technology acceptance.

Conclusions:

Gaps and challenges identified through this review can provide a focus for surveys and interviews to elicit additional feedback from clinicians and other healthcare stakeholders for confirming and prioritizing issues related to development of appropriate tools and educational resources for addressing AF notifications from CWDs. These resources should target clinicians, patients, and healthcare systems, with the goals of facilitating clinician/patient engagement and using an evidence-based approach for establishing guidelines/frameworks for administrative workflow and patient care pathways. The results of this review should also provide the impetus for active involvement of medical societies in developing appropriate tools and resources for guiding use of CWDs for AF detection.