This RCT1 enrolled 437 secondary care patients aged ≥65 years (mean 75) with CHA₂DS₂-VASc scores ≥2 in men and ≥3 in women. Participants were assigned to 6-month (180-day) monitoring, using an Apple smartwatch with photoplethysmography and single-lead ECG functions, or to standard care.
Over 6 months, atrial fibrillation (AF) was detected in 21 patients (9.6%) in the intervention group versus 5 (2.3%) in controls. Several asymptomatic AF episodes were identified only in the intervention group, while paroxysmal AF occurred in both groups.
Although relatively expensive, wearable ECG monitoring can be clinically useful. Anecdotally, a 78-year-old patient presented with an irregular pulse that was not detected on Holter monitoring. She was started on a DOAC and rate-control therapy. Using her smartwatch, she recorded episodes of irregular pulse and emailed a PDF to a cardiologist, who diagnosed atrial ectopics. Anticoagulation and other medications were subsequently discontinued, and she remains well and medication-free.
