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Perez et al (N Engl J Med 2019;381:1909, PMID 31722151) assessed the ability of a
smartwatch application (app) to identify atrial fibrillation (AF). Participants without
AF used a smartphone app for consent. If the algorithm identified possible AF, a telemedicine
visit was initiated and an electrocardiography (ECG) patch was mailed to the participant.
The main objectives were to estimate the proportion of notified participants with
AF shown on an ECG patch and the positive predictive value of irregular pulse intervals.
The investigators recruited 419,297 participants over 8 months. Over a median of 117
days of monitoring, 2161 participants (0.52%) received notifications of an irregular
pulse. Among the 450 participants with ECG patches containing analyzable data, AF
was present in 34%. Of 1376 notified participants who returned a 90-day survey, 57%
contacted health care providers outside the study. The authors conclude that this siteless pragmatic study design provides a foundation
for large-scale pragmatic studies in which outcomes or adherence can be reliably assessed
with user-owned devices.
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