Diagnostic accuracy of smart gadgets/wearable devices in detecting atrial fibrillation in primary prevention: a meta-analysis

FUNDING ACKNOWLEDGEMENTS: Type of funding sources: None. INTRODUCTION: Atrial fibrillation (AF) is the most common sustained arrhythmia and an important risk factor for stroke and heart. Recent technology advances have allowed for heart rhythm monitoring using smart gadgets/wearable devices which can be used for early AF diagnosis. PURPOSE: We performed a systemic review and meta-analysis to assess the accuracy of AF diagnosis by smart gadgets/wearable devices in primary prevention. METHODS: We systematically searched Medline, Embase and Cochrane electronic databases up to September 22th, 2022 for observational studies of the diagnostic accuracy of smartphone application, wrist-worn wearables and external devices in detecting AF in primary prevention. Studies with 12-lead ECG or single-lead ECG interpreted by a cardiologist as gold standard were included. We calculated the area under the curve (AUC) of the summary receiver operating characteristic curves (SROC) and pooled sensitivities and specificities. RESULTS: A total of 28 studies were included enrolling 13463 patients, 57%(95% CI: 55-59%) male with average age of 65.3years (95% CI: 60.1 – 70.4). The pooled prevalence of AF was found to be 13% (95% CI 10 – 15%). In the overall analysis of all devices, the AUC was 0.99 (95% CI: 0.97-0.99)(Figure 1), the sensitivity 93%(95% CI: 89 – 95%) and the specificity 97%(95% CI: 95 – 98%) (Figure 2). Wrist-worn wearables had AUC of 0.97 (95% CI: 0.94-0.99), the sensitivity 83%(95% CI: 52 – 96%) and the specificity 98%(95% CI: 87 – 100%). Smartphone applications had AUC of 0.97 (95% CI: 0.96-0.98), the sensitivity 92%(95% CI: 77 – 98%) and the specificity 95%(95% CI: 91 – 97%). External devices had AUC of 0.99 (95% CI: 0.97-0.99), the sensitivity 94%(95% CI: 91 – 96%) and the specificity 97%(95% CI: 95 – 98%). Single-lead ECG had AUC of 0.99 (95% CI: 0.97- 0.99), the sensitivity 93%(95% CI: 88 – 96%) and the specificity 91%(95% CI: 78 – 97%). photoplethysmography pulse waveform technology (PPG) had AUC of 0.97 (95% CI: 0.96-0.98), the sensitivity 91%(95% CI: 78 – 97%) and the specificity 95%(95% CI: 91 – 97%). Pulse beat interval technology had AUC of 0.99 (95% CI: 0.98-0.99), the sensitivity 95%(95% CI: 90 – 98%) and the specificity 96%(95% CI: 93 – 98%) CONCLUSIONS: Smartphone application, wrist-worn devices and external devices have excellent diagnostic accuracy in atrial fibrillation diagnosis in primary prevention. [Figure: see text] [Figure: see text]