![]() The yield was higher in older than younger people. Of 450 people who returned the patches, AF was confirmed in 153 (34%) 20% had continuous AF. Participants began wearing the patches about 13 days after the notification, for about 6 days. The researchers urgently contacted 20 people: 18 with AF and a rate >200 beats/minute, 1 with a pause >6 seconds, and 1 with nonsustained ventricular tachycardia >6 seconds.įor confirmation, electrocardiographic patches were mailed to 658 participants with nonurgent symptoms. participants enrolled via an app, owned Apple Watches and iPhones, and had no prior AF.ĭuring the study, 2161 people were notified of an irregular pulse, of whom 79% were excluded for various reasons, including 1216 who failed to attend a telemedicine visit. The industry-sponsored, prospective, open-label, siteless, pragmatic Apple Heart Study tested an algorithm to identify AF ( NCT03335800). The Apple Watch has an optical sensor that can detect heart rates, thus introducing the possibility of detecting atrial fibrillation (AF). Krumholz, MD, SM reviewing Perez MV et al. N Engl J Med 2019 Nov 14 Campion EW and Jarcho JA. N Engl J Med 2019 Nov 14 The Era of App-Detected Atrial Fibrillation Is Coming, but Evaluations Are Ongoing The following NEJM Journal Watch summary explains the study and results in more detail: How do health care professionals deal with such large volumes of data? How do clinicians interpret findings using non-validated algorithms? How will patient privacy be maintained? Furthermore, only 20.8% of notified patients sought further testing, and atrial fibrillation was confirmed in approximately one third of those patients, thereby bringing into question the clinical value.Īlthough groundbreaking, the study raises new questions about technology in healthcare. But only 0.52% of participants received irregular pulse notifications, likely reflecting the 41-year-old mean age of study participants. The study size, siteless design, and ability to engage the patient in their own care are remarkable. ![]() The goal of the Apple study was large-scale passive screening for a common disease and the results are both remarkable and disappointing. If an arrhythmia was suspected, the participant was prompted to initiate a telemedicine visit for a more detailed evaluation. The watch utilized optical sensors to intermittently generate 1-minute “tachograms,” that were subsequently analyzed as regular or irregular. Notably, the study strengths were its practicality and size: almost 420,000 patients were recruited remotely with consent, data, and communication transferred through the downloaded application, making it a “siteless” study. #Apple pages trial trialIn the Apple Heart Study, recently published in NEJM, investigators designed a pragmatic trial to test the ability of an Apple smartwatch application to identify some of the estimated 700,000 patients in the United States with undiagnosed atrial fibrillation. With advances in technology, leading companies including Amazon, Uber, and Apple are now entering this burgeoning field. The application of the data for medical purposes is the fundamental principle of mobile health. ![]() These devices continuously and passively collect data from users including pulse rates, location, and three-dimensional motion. In North America, 81% of adults own a smart phone and 17% own a wearable technological device such as a smartwatch. ![]()
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