Table 2.
Studies using different heart rate monitoring techniques to detect atrial arrhythmias in older adults with focus on wearables
| Study | Monitoring | Technique | Author, study acronym subgroup/own analysis | Population | Design, intervention | Mean age (+/− Std.) | Female (%) | n | Atrial arrhythmia IR (%) |
|---|---|---|---|---|---|---|---|---|---|
| General population/community based/at risk cohorts, remote | Continuous monitoring | single lead ECG | Bowman/Casadei et al. AMALFI From ISRCTN | General population based Region: K Age: ≥ 64 Inclusion: CHA2DS2-VASc ≥ 4 in woman or ≥ 3 in men Exclusion: Known AF: excluded | Sequence: continuous, 14 days Biodata: single lead ECG Device: ZioPatch | Analysis ongoing/unpublished | |||
| Langer et al. 202129 AWARE-AF program | Community based, recruited from outpatient cardiology Region: Canada Age: ≥ 65 Inclusion: ≥ 1 of poAF, ST/TIA or ≥ 75 years old + ≥ 2 of HF, HT, DM, CKD, OSAS, CVD, EF < 35%, significant DDys Exclusion: implanted PM/ICD Known AF: excluded | Sequence: continuous, 7 days Biodata: single lead ECG Device: Cardiostat, Canada | 78.7 ± 6.1 | 42% | 942 | 2.7 (1.8–4.0) | |||
| Gladstone et al. 202130 SCREEN-AF | General population based, recruited from GP practices Region: Canada, Germany Age: ≥ 75 years Inclusion: CHADS2 ≥ 2 Exclusion: implantable PM/ICD/ILR, contraindication for OAC Known AF: excluded | Sequence: continuous, 14 days Biodata: single lead ECG Device: ZioPatch | 80 ± 4 | 57% | 434 | 5.3 (3.4–8) | |||
| Kemp Gudmundsdottir et al. 202031 STROKESTOP II High-risk subgroup | General population based Region: Stockholm Age: 75 or 76 years old Inclusion: NT-proBNP ≥ 125 ng/L Exclusion: -Known AF: excluded | Sequence: continuous, 14 days Biodata: single lead ECG Device: Novacor R-test 4 evolution | N/A | 60% | 3766 | 4.4 (3.8–5.1) | |||
| Rooney et al. 201932 ARIC | Community based Region: USA Age: ≥ 75 years Inclusion: Exclusion: implantable PM/ICD/ILR, skin allergic Known AF: separated | Sequence: continuous, 14 days Biodata: single lead ECG Device: ZioPatch | 79.2 ± 4.6 | 58% | 2244 | 2.5 (1.9–3.2) | |||
| Steinhubl et al. 201833 mSToPS | General population based (all subscribers of a certain health care plan9 Region: USA Age: ≥ 75 years or ≥ 65 years + Female + 1 comorbidity or ≥ 55 years + Male + 1 comorbidity Inclusion: -Exclusion: implantable PM/ICD, on OAC, known AT, known Aflutter Known AF: excluded | Sequence: continuous, 2 × 14 days Biodata: single lead ECG Device: ZioPatch | 73.7 ± 7.0 | 41% | 1738 | 2.9 (2.2–3.8) | |||
| Heckbert et al. 201834 MESA (substudy) | General population based (6 communities) Region: USA Age: ≥ 18 years Inclusion: -Exclusion: skin allergy to tape/adhesives Known AF: excluded | Sequence: continuous, 14 days Biodata: single lead ECG Device: ZioPatch | 75 ± 8 | 48% | 804 | 4.0 (2.7–5.6) | |||
| PPG | Perez et al. 201915 Apple Heart Study own analysis of participants aged ≥ 65 years | General population based Region: USA Age: ≥ 18 years Inclusion: Apple Watch owner Exclusion: -Known AF: included | Sequence: continuous Biodata: PPG + ECG patch Device: Apple Watch | N/A | 42%c | 24 626 | 3.1 (2.9–3.3)a | ||
| Guo et al. 201916 Pre-MAFA II (Huawei Heart Study) own analysis of participants aged ≥ 65 years | General population based Region: China Age: ≥ 18 years Inclusion: Huawei smartphone owner Exclusion: -Known AF: included | Sequence: continuous Biodata: PPG Device: Huawei Watch or Honor Watch or Honor Band | N/A | 13%c | 3419 | 2.8 (2.3–3.4) | |||
| Lubitz et al. 202120 FITBIT Heart Study Design paper | General population based Region: USA Age: ≥ 22 years Inclusion: Fitbit device owner Exclusion: on OAC, implanted PM/ICD Known AF: excluded (AF/AFlutter) | Sequence: continuous Biodata: PPG + ECG patch Device: Fitbit Ionic, Charge 3, Charge 4, Versa, Versa Lite, Versa 2, Versa 3, Sense, Inspire HR, Inspire 2 | Analysis ongoing/unpublished | ||||||
| intermittent monitoring | single lead ECG | Berge et al. 201835 ACE1950 Follow-Up | Community based Region: Sweden Age: 65 years Inclusion: ≥ 1 of HT, DM, HF, ST/TIA, VD Exclusion: -Known AF: excluded | Sequence: intermittent, 2 × daily, 14 days Biodata: single lead ECG Device: Zenicor | 65 | 44% | 1510 | 0.9 (0.5–1.5) | |
| Ghazal et al. 202036 | Community based Region: Stockholm regional, Sweden Age: ≥ 65 years Inclusion: -Exclusion: -Known AF: excluded | Sequence: intermittent, 3 × daily, 14 days Biodata: single lead ECG Device: Zenicor | 72.1 (68.7, 75.9)b | 61% | 1010 | 2.7 (1.8–3.9) | |||
| Halcox et al. 201737 REHEARSE-AF | Community based, recruited from GP practices Region: Aberdeen region, UK Age: ≥ 65 Inclusion: CHA2DS2-VASc ≥ 2 (non-sex) Exclusion: on OAC, known CI for OAC, implanted PM/ICD Known AF: excluded | Sequence: intermittent, 2 × weekly, 1 year Biodata: single lead ECG Device: AliveCor | 72.6 ± 5.4 | 52% | 500 | 3.4 (2.0–5.4) | |||
| Svennberg et al. 201538 STROKESTOP (screening results) | General population based Region: Stockholm + Halland county, Sweden Age: 75 or 76 years old Inclusion: -Exclusion: -Known AF: separate | Sequence: intermittent, 2 × daily, 14 days Biodata: single lead ECG Device: Zenicor | N/A | 55% | 6507 | 3.8 (3.3–4.3) | |||
| once | single lead ECG | Poulsen et al. 202239 | Community based, at preventive home visits Region: 3 Danish municipals Age: ≥ 65 years Inclusion: understanding Danish Exclusion: on OAC, home care or living in nursing home Known AF: excluded | Sequence: once per patient (2 repeated measures) Biodata: single lead ECG Device: Zenicor | 80.9 (4.7) | 56% | 477 | 1.5 (0.6–3) | |
| Senoo et al. 202240 | Community based, at AF awareness campaign symposiums Region: Kyoto, Japan Age: ≥ 65 years Inclusion: -Exclusion: -Known AF: separate | Sequence: once per patient, 30 s Biodata: single lead ECG Device: Complete, Omron, Kyoto | 72.4 ± 5.8 | 52% | 1607 | 0.9 (0.5–1.5) | |||
| Systematic, GP-/Pharmacy-based, stationary | Once, cross-sectional | single lead ECG | Chen et al. 202041 AF-CATCH, pre-phase | Community based, community health centres Region: Shanghai, China Age: ≥ 65 years Inclusion: -Exclusion: -Known AF: separate | Sequence: once per patient, 30 s Biodata: single lead ECG Device: AliveCor | 71.6 ± 6.3 | 56% | 4370 | 0.5 (0.3–0.8) |
| Zaprutko et al. 202042 | General population based, recruited from 10 pharmacies Region: 6 cities in 3 regions of Poland Age: ≥ 65 years Inclusion: -Exclusion: -Known AF: excluded | Sequence: once per patient, 30 s Biodata: single lead ECG Device: AliveCor | 73.7 ± 6.5 | 68% | 525 | 1.4 (0.6–2.8) | |||
| Orchard et al. 202043 AF SMART II | Community based, recruited at GP practices Region: rural Australia Age: ≥ 65 years Inclusion: -Exclusion: implantable PM/ICD, on OAC Known AF: excluded | Sequence: once per patient, 30 s Biodata: single lead ECG Device: AliveCor | 75.1 ± 6.8 | 53% | 3103 | 1.2 (0.8–1.7) | |||
| Gwynn et al. 202044 own analysis of participants aged ≥ 65 years | Community based at 16 Aboriginal Community Health Organizations Region: rural Australia Age: ≥ 45 years Inclusion: Aboriginal heritage Exclusion: -Known AF: separated | Sequence: once per patient, 30 s Biodata: single lead ECG Device: AliveCor | N/A | 56% | 146 | 0.6 (0.0–3.7) | |||
| Sun et al. 202245 Hong Kong Outpatient AF screening study | Outpatient clinics (2 cardiology, 2 IM, 1 geriatric) Region: Hong Kong region Age: ≥ 65 years Inclusion: -Exclusion: dementia, terminal illness, unable to understand informed consent Known AF: separated | Sequence: once per patient, 30 s Biodata: single lead ECG Device: AliveCor | 76.4 ± 7.8 | 49% | 9734 | 3.0 (2.7–3.4) | |||
| combination | Verbiest-van Gurp et al. 202246 | Outpatient clinics (2 cardiology, 2 IM, 1 geriatric) Region: Hong Kong region Age: ≥ 65 years Inclusion: Exclusion: known AF Known AF: separated | Sequence: once per patient Biodata: single lead ECG/BP/palpation Device: MyDiagnostick, Microlife BP Monitor, Radial pulse palpation | 73.5 ± 5.5 | 54% | 4339 | 0.8 (0.6–1.1) | ||
| BP monitor | Jatau et al. 202247 What’s Your Beat? | General population based, health centers, recruitment via media campaigns Region: Tasmania, Australia Age: ≥ 65 years Inclusion:—Exclusion: severe dementia, known cardiac arrhythmia, implantable PM/ICD Known AF: excluded | Sequence: once per patient Biodata: BP monitor Device: Microlife | 71.0 (68.0–76.0) | 59% | 1704 | 0.9 (0.5–1.5) | ||
| Intermittent | BP monitor | Denas et al. 202048 | General population based, GP practices Region: Veneto, Italy Age: ≥ 65 years Inclusion: -Exclusion: -Known AF: excluded | Sequence: 3 consecutive measurements per visit, unsystematically intermittent at visits over in average 410 days per patient Biodata: BP monitor Device: Microlife | 75.5 ± 7.0 | 58% | 14 987 | 2.5 (2.3–2.8) | |
| single lead ECG | Zhang et al. 202149 AF-CATCH Quarterly-screened subgroup | Community based, community health centers Region: Shanghai Age: ≥ 65 years Inclusion: -Exclusion: -Known AF: excluded | Sequence: intermittent, quarterly Biodata: single lead ECG Device: AliveCor | 71.3 ± 6.1 | 56% | 2841 | 1.4 (1.0–1.9) | ||
| Lubitz et al. 202250 VITAL-AF | Community based at GP practices Region: Massachusetts, USA Age: ≥ 65 years Inclusion: -Exclusion: -Known AF: excluded | Sequence: intermittent over 12 months at GP visits Biodata: single lead ECG Device: AliveCor | 73.9 ± 6.8 | 60% | 15 393 | 1.7 (1.5–1.9) | |||
| combination | Watanabe et al. 202251 SCAN-AF | Hospital-affiliated outpatient clinics Region: Japan Age: ≥ 65 years Inclusion: CHA2DS2-VASc ≥ 2 or CHADS2 ≥ 1 Exclusion: known AF, use of AAD, inability to use the monitoring devices Known AF: excluded | Sequence: intermittent over 24 weeks Biodata: BP oscillogram, single lead ECG Device: Omron; myBeat | 74.0 (69.0–79.0) | 50% | 1148 | 0.8 (0.4–1.5) | ||
| Cardiology patients without history of AF | continuous | Single lead ECG (ILR) | Svendsen et al. 20216 LOOP | Cardiology patients, 4 centers Region: Denmark Age: 70–90 years Inclusion: ≥ 1 of HT, DM, ST/TIA, HF Exclusion: on OAC, known CI for OAC, implanted PM/ICD Known AF: excluded | Sequence: continuous, 64.5 months (59.3, 69.8)bBiodata: single lead ECG (ILR) Device: Medtronic Reveal LINQ ILR | 74.7 ± 4.1 | 47% | 1501 | 31.8 (29.0–34.8) |
| Philippsen et al. 201752 | Diabetes and cardiology outpatient clinics at the Hospital of Southern Jutland Region: USA Age: ≥ 65 years Inclusion: HT (treated with ≥ 2 antihypertensives) and DM (treated with any antidiabetics or insulin) Exclusion: on OAC, EF < 45%, valvular disease needing intervention, implanted PM/ICD, known ischemic heart disease, ST/TIA, PAD, thyrotoxicosis, end-stage renal failure, severe obesity Known AF: excluded | Sequence: continuous, until ERI Biodata: PPG (ILR) Device: Medtronic ILR (Reveal XT or Reveal LINQ) | 71.3 (67.4, 75.1)b | 37% | 82 | 20.7 (12.0–33.2) | |||
The table lists the name of the study, the population studied, the design, age, and sex of the population, the number of participants, and the incidence rate of atrial arrhythmias with a 95% confidence interval. When age subgroup data was available or calculable, the study was included and parameters are reported for the population aged ≥ 65 years. Two studies are included of which only the design has been published (Lubitz et al.) or reported on a clinical trials website (AMALFI). Two implantable loop recorder studies are added at the bottom of the table.
Abbreviations: AAD, antiarrhythmic drug(s); BP, blood pressure; 95% CI, 95% confidence interval; CI, contraindication; CVD, any cardiovascular disease; DDys, diastolic dysfunction in echocardiography; DM, diabetes mellitus; EF, ejection fraction; GP, general practitioner; HF, heart failure; HT, hypertension; ICD, implantable cardioverter-defibrillator; ILR, implantable loop recorder; IM, internal medicine; IR, Incidence rate; IR/100 000, Incidence rate per 100 000 screened; n, Population size used for incidence rate calculation; OAC, oral anticoagulation; OSAS, obstructive sleep apnea syndrome; PAD, peripheral artery disease; PM, pacemaker; poAF, postoperative AF; ST/TIA, stroke or TIA; VD, vascular disease (in CHA2DS2-VASc).
a
This study included participants without knowledge of the history of atrial fibrillation but was included in the review due to its sample size and population-wide approach. Reported is the incidence rate of screen-positive participants (irregular pulse notification). Of these, 34% were diagnosed on a subsequent Holter ECG.
b
Median age and interquartile range (IQR) are reported.
c
Proportion of females not available for reported age group.