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Smartwatches might become an alternative to Holter monitoring in high-risk patients
Clinical Question
Can a smartwatch be used to replace Holter monitoring?
Bottom line
Wearable technology — in this case, a smartwatch — might be where we're going with diagnostic monitoring. In this study, the Garmin Forerunner 945 smartwatch overidentified AF as compared with simultaneous Holter monitoring in this small, high-prevalence (56%) sample. For low-likelihood populations, this might cause more harm than good. I have another type of smartwatch that has a similar monitor (which I have disabled). Since I have a substantially lower risk of AF, these numbers indicate that I would have a greater than 50:50 chance of a false-positive result if the watch recorded an event. 1c
Reference
Study design: Diagnostic test evaluation
Funding: Industry
Setting: Outpatient (specialty)
Synopsis
These authors enrolled consecutive 200 adults (average age 66 years) who were to undergo 24-hour Holter monitoring. Most (61%) had a history of atrial fibrillation (AF), and half were already taking a beta-blocker. In addition to the Holter monitor, patients also wore a smartwatch with photoplethysmography sensors for the continuous monitoring of pulse rate (Garmin Forerunner 945). Over the 24 hours, AF was recorded by Holter monitor in 112 of the patients (56%); 96% of these patients had a previous history of AF. The smartwatch detected AF in 109 of these patients (sensitivity = 97.3%). The watch also recorded 10 instances of AF in the 88 patients without Holter-recorded AF during the 24 hours (specificity = 88.6%). These numbers translate into a positive likelihood ratio of 8.6 and a negative likelihood ratio of 0.03, meaning you can take a negative result to the bank, but a positive result is only moderately indicative of an episode.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Smart watches have a role in identifying AF
Smart watches with photo plethysmography are likely to have a big 994612 in future in recognising the AF and probably other tachyarrhythmias too
Smart Watch
We have to be careful that new technology gives a true and reliable picture of health status to avoid potentially harmful and unnecessary interventions.
smart watch
It is not matter of recording. Who is going to read that. It is matter of interpretation of the recording.
smartwatch monitoring atfib
false positives
smart watch for AF
more patients might be able to use this is AF might be an issue
Cost of smart watches
It would be of interest to know the demographics of those who can afford a smart watch (and the necessary electronic supports) and whether on a population basis this is a realistic alternative.