The acceptability of wearables for atrial fibrillation screening: Interim analysis of the SAFER Wearables Study

Abstract

Background: Wearable devices could enhance or complement existing approaches to atrial fibrillation (AF) screening, with potential utility both for detecting AF and measuring AF burden. However, there is limited research on the acceptability of wearables in older adults, who are the typical target population for AF screening. In this paper we report an interim analysis of the SAFER Wearables Study, a study assessing the acceptability of wearables for AF screening. The aim was to identify factors influencing the acceptability of wearables in older adults. Methods: The study enrolled community-dwelling adults aged 65 and over, who were asked to wear three wearable rhythm monitoring devices for one week: a photoplethysmography-based wristband, a smartwatch-style device with continuous photoplethysmography monitoring and the functionality to obtain single-lead electrocardiograms (ECGs) on demand, and an ECG chest patch. The smartwatch-style device was configured to vibrate four times per day and upon recognising an irregular pulse to prompt the user to take an ECG. Feedback on the acceptability of the devices was collected formally via a questionnaire, and informally via telephone discussions. Results: 95% of the 21 participants reported being happy to wear any of the devices for one week in the questionnaire. However, 24% of participants removed the chest patch early due to skin irritation, and 38% reported that it caused skin irritation. In addition, participants suggested adjusting the chest patch electrode positioning to ensure its suitability for women. The wrist-worn devices were generally better tolerated. Participants suggested ensuring that the vibrations to prompt ECG recordings were stronger, and did not occur at night. Conclusion: The findings provide insights into factors influencing the acceptability of wearables in older adults, a target population for AF screening. Several strategies to increase acceptability were identified with relevance to other applications such as obstructive sleep apnea detection.