The following article is a part of conference coverage from the 2021 American Association of Nurse Practitioners National Conference (AANP 2021), held virtually from June 15 to June 20, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading NPs. Check back for more from AANP 2021.

 

Wearable devices such as smartwatches have demonstrated accuracy in screening individuals for atrial fibrillation, but must be used with caution as the technology holds both “promises and pitfalls,” according to research presented in a poster session at the 2021 American Association of Nurse Practitioners National Conference (AANP 2021).

Wearable electrocardiogram (ECG) devices have become popular among patients in recent years. Using photoplethysmography (PPG) embedded in a smartwatch or wristband, patients can take an ECG with the tap of a button. Recent studies suggest that these devices are accurate, with reliability ranging from 0.79% to 0.99%, explained study author Margaret Harvey, PhD, APRN, of the College of Nursing at the University of Tennessee Health Science Center and the Cardiology Electrophysiology Division at the University of Tennessee Methodist Physicians, Memphis.


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In the Apple Heart Study, 84% of Apple Watch notifications of irregular pulse were concordant with atrial fibrillation. In the Huawei Heart Study, the positive predictive value of PPG signals was 91.6%.

However, questions still remain about the usability of health data from wearable devices and whether these products should be considered consumer or medical devices, Dr. Harvey noted.

Pitfalls of this technology may include false positives, overall accuracy, and low yield — particularly in “asymptomatic consumers who may incur unnecessary stress and costs” associated with false-positive findings, Dr Harvey noted.

Wearables also have the potential to generate a “plethora” of data, which may put a strain on providers who need to interpret this data, Dr Harvey said. “There are still many questions regarding how PPG-based wearables will affect management and patient outcomes.”

In 2020, expert consensus from 4 cardiology societies — European Heart Rhythm Association, Heart Rhythm Society, Asia Pacific Heart Rhythm Society, and Latin American Heart Rhythm Society —determined that PPG-based wearable devices may “provide diagnostic data that contributes to disease detection and management” when integrated into a clinical setting. Although, to achieve this, the right tool must be used for the right outcome in the right population. 

These devices can be considered screening tools for people at increased risk of atrial fibrillation because of increased age or cardiovascular risk factors, Dr Harvey concluded, adding that clinicians should familiarize themselves with both the benefits and challenges associated with using these technologies to screen consumers for atrial fibrillation, Dr. Harvey concluded. 

Reference

Harvey M. Promises and pitfalls of wearable devices as a screening tool for atrial fibrillation. Poster presented at: 2021 American Association of Nurse Practitioners National Conference; June 15-20, 2021. Poster 33.

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