Will Apple devices' passive atrial fibrillation detection prevent strokes? Estimating the proportion of high-risk actionable patients with real-world user data.

Creator(s)

Keith Feldman, Children's Mercy HospitalFollow
Ray G. Duncan
An Nguyen
Galen Cook-Wiens
Yaron Elad
Teryl Nuckols
Joshua M. Pevnick

Document Type

Article

Publication Date

5-11-2022

Identifier

DOI: 10.1093/jamia/ocac009; PMCID: PMC9093037

Abstract

OBJECTIVE: Utilizing integrated electronic health record (EHR) and consumer-grade wearable device data, we sought to provide real-world estimates for the proportion of wearers that would likely benefit from anticoagulation if an atrial fibrillation (AFib) diagnosis was made based on wearable device data.

MATERIALS AND METHODS: This study utilized EHR and Apple Watch data from an observational cohort of 1802 patients at Cedars-Sinai Medical Center who linked devices to the EHR between April 25, 2015 and November 16, 2018. Using these data, we estimated the number of high-risk patients who would be actionable for anticoagulation based on (1) medical history, (2) Apple Watch wear patterns, and (3) AFib risk, as determined by an existing validated model.

RESULTS: Based on the characteristics of this cohort, a mean of 0.25% (n = 4.58, 95% CI, 2.0-8.0) of patients would be candidates for new anticoagulation based on AFib identified by their Apple Watch. Using EHR data alone, we find that only approximately 36% of the 1802 patients (n = 665.93, 95% CI, 626.0-706.0) would have anticoagulation recommended even after a new AFib diagnosis.

DISCUSSION AND CONCLUSION: These data suggest that there is limited benefit to detect and treat AFib with anticoagulation among this cohort, but that accessing clinical and demographic data from the EHR could help target devices to the patients with the highest potential for benefit. Future research may analyze this relationship at other sites and among other wearable users, including among those who have not linked devices to their EHR.

Journal Title

Journal of the American Medical Informatics Association : JAMIA

Volume

29

Issue

6

First Page

1040

Last Page

1049

Keywords

atrial fibrillation; mobile health (mHealth); patient-generated data; precision health

Comments

Grant support

• Cedars-Sinai Precision Health

Recommended Citation

Feldman K, Duncan RG, Nguyen A, et al. Will Apple devices' passive atrial fibrillation detection prevent strokes? Estimating the proportion of high-risk actionable patients with real-world user data. J Am Med Inform Assoc. 2022;29(6):1040-1049. doi:10.1093/jamia/ocac009