Fully Automated Photoplethysmography-Based Wearable Atrial Fibrillation Screening in a Hospital Setting.

Background/

Objectives

Atrial fibrillation (AF) remains a major risk factor for stroke. It is often asymptomatic and paroxysmal, making it difficult to detect with conventional electrocardiography (ECG). While photoplethysmography (PPG)-based devices like smartwatches have demonstrated efficacy in detecting AF, they are rarely integrated into hospital infrastructure. The study aimed to establish a seamless system for real-time AF screening in hospitalized high-risk patients using a wrist-worn PPG device integrated into a hospital's data infrastructure.

Methods

In this investigator-initiated prospective clinical trial conducted at the University Hospital Basel, patients with a CHA2DS2-VASc score ≥ 2 and no history of AF received a wristband equipped with a PPG sensor for continuous monitoring during their hospital stay. The PPG data were automatically transmitted, analyzed, stored, and visualized. Upon detection of an absolute arrhythmia (AA) in the PPG signal, a Holter ECG was administered.

Results

The analysis encompassed 346 patients (mean age 72 ± 10 years, 175 females (50.6%), mean CHA2DS2-VASc score 3.5 ± 1.3)). The mean monitoring duration was 4.3 ± 4.4 days. AA in the PPG signal was detected in twelve patients (3.5%, CI: 1.5-5.4%), with most cases identified within 24 h (p = 0.004). There was a 1.3 times higher AA burden during the nighttime compared to daytime (p = 0.03). Compliance was high (304/346, 87.9%). No instances of AF were confirmed in the nine patients undergoing Holter ECG.

Conclusions

This study successfully pioneered an automated infrastructure for AF screening in hospitalized patients through the use of wrist-worn PPG devices. This implementation allowed for real-time data visualization and intervention in the form of a Holter ECG. The high compliance and early AA detection achieved in this study underscore the potential and relevance of this novel infrastructure in clinical practice.