Accuracy, Usability, and Adherence of Smartwatches for Atrial Fibrillation Detection in Older Adults After Stroke: Randomized Controlled Trial.

Q2 Medicine JMIR Cardio Pub Date : 2023-11-28 DOI:10.2196/45137

Eric Y Ding, Khanh-Van Tran, Darleen Lessard, Ziyue Wang, Dong Han, Fahimeh Mohagheghian, Edith Mensah Otabil, Kamran Noorishirazi, Jordy Mehawej, Andreas Filippaios, Syed Naeem, Matthew F Gottbrecht, Timothy P Fitzgibbons, Jane S Saczynski, Bruce Barton, Ki Chon, David D McManus

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Abstract

Background: Atrial fibrillation (AF) is a common cause of stroke, and timely diagnosis is critical for secondary prevention. Little is known about smartwatches for AF detection among stroke survivors. We aimed to examine accuracy, usability, and adherence to a smartwatch-based AF monitoring system designed by older stroke survivors and their caregivers.

Objective: This study aims to examine the feasibility of smartwatches for AF detection in older stroke survivors.

Methods: Pulsewatch is a randomized controlled trial (RCT) in which stroke survivors received either a smartwatch-smartphone dyad for AF detection (Pulsewatch system) plus an electrocardiogram patch or the patch alone for 14 days to assess the accuracy and usability of the system (phase 1). Participants were subsequently rerandomized to potentially 30 additional days of system use to examine adherence to watch wear (phase 2). Participants were aged 50 years or older, had survived an ischemic stroke, and had no major contraindications to oral anticoagulants. The accuracy for AF detection was determined by comparing it to cardiologist-overread electrocardiogram patch, and the usability was assessed with the System Usability Scale (SUS). Adherence was operationalized as daily watch wear time over the 30-day monitoring period.

Results: A total of 120 participants were enrolled (mean age 65 years; 50/120, 41% female; 106/120, 88% White). The Pulsewatch system demonstrated 92.9% (95% CI 85.3%-97.4%) accuracy for AF detection. Mean usability score was 65 out of 100, and on average, participants wore the watch for 21.2 (SD 8.3) of the 30 days.

Conclusions: Our findings demonstrate that a smartwatch system designed by and for stroke survivors is a viable option for long-term arrhythmia detection among older adults at risk for AF, though it may benefit from strategies to enhance adherence to watch wear.

Trial registration: ClinicalTrials.gov NCT03761394; https://clinicaltrials.gov/study/NCT03761394.

International registered report identifier (irrid): RR2-10.1016/j.cvdhj.2021.07.002.

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智能手表在老年人脑卒中后房颤检测中的准确性、可用性和依从性:随机对照试验

背景:房颤(AF)是卒中的常见病因，及时诊断对二级预防至关重要。人们对智能手表在中风幸存者中检测心房颤动所知甚少。我们的目的是检查老年中风幸存者及其护理人员设计的基于智能手表的房颤监测系统的准确性、可用性和依从性。目的:本研究旨在探讨智能手表在老年卒中幸存者中检测房颤的可行性。方法:Pulsewatch是一项随机对照试验(RCT)，在该试验中，中风幸存者要么接受用于AF检测的智能手表-智能手机组合(Pulsewatch系统)加上心电图贴片，要么单独接受贴片，为期14天，以评估系统的准确性和可用性(第一阶段)。随后，参与者被重新随机分配到可能额外使用30天的系统，以检查佩戴手表的依从性(第二阶段)。口服抗凝剂无重大禁忌症。通过与心脏科医师过读心电图贴片进行比较来确定房颤检测的准确性，并使用系统可用性量表(SUS)评估其可用性。依从性以30天监测期间每天佩戴手表的时间来衡量。结果:共纳入120名参与者(平均年龄65岁;50/120, 41%女性;106/120, 88%白人)。Pulsewatch系统检测AF的准确率为92.9% (95% CI 85.3%-97.4%)。平均可用性得分为65分(满分100分)，参与者在30天中平均佩戴21.2天(标准差8.3)。结论:我们的研究结果表明，由中风幸存者设计并为其设计的智能手表系统对于有房颤风险的老年人长期心律失常检测是一种可行的选择，尽管它可能受益于增强手表佩戴依从性的策略。试验注册:ClinicalTrials.gov NCT03761394;https://clinicaltrials.gov/study/NCT03761394.International注册报告标识符(irrid): RR2-10.1016/j.cvdhj.2021.07.002。

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