A Smartwatch System for Continuous Monitoring of Atrial Fibrillation in Older Adults After Stroke or Transient Ischemic Attack: Application Design Study

Abstract

Background The prevalence of atrial fibrillation (AF) increases with age and can lead to stroke. Therefore, older adults may benefit the most from AF screening. However, older adult populations tend to lag more than younger groups in the adoption of, and comfort with, the use of mobile health (mHealth) apps. Furthermore, although mobile apps that can detect AF are available to the public, most are designed for intermittent AF detection and for younger users. No app designed for long-term AF monitoring has released detailed system design specifications that can handle large data collections, especially in this age group. Objective This study aimed to design an innovative smartwatch-based AF monitoring mHealth solution in collaboration with older adult participants and clinicians. Methods The Pulsewatch system is designed to link smartwatches and smartphone apps, a website for data verification, and user data organization on a cloud server. The smartwatch in the Pulsewatch system is designed to continuously monitor the pulse rate with embedded AF detection algorithms, and the smartphone in the Pulsewatch system is designed to serve as the data-transferring hub to the cloud storage server. Results We implemented the Pulsewatch system based on the functionality that patients and caregivers recommended. The user interfaces of the smartwatch and smartphone apps were specifically designed for older adults at risk for AF. We improved our Pulsewatch system based on feedback from focus groups consisting of patients with stroke and clinicians. The Pulsewatch system was used by the intervention group for up to 6 weeks in the 2 phases of our randomized clinical trial. At the conclusion of phase 1, 90 trial participants who had used the Pulsewatch app and smartwatch for 14 days completed a System Usability Scale to assess the usability of the Pulsewatch system; of 88 participants, 56 (64%) endorsed that the smartwatch app is “easy to use.” For phases 1 and 2 of the study, we collected 9224.4 hours of smartwatch recordings from the participants. The longest recording streak in phase 2 was 21 days of consecutive recordings out of the 30 days of data collection. Conclusions This is one of the first studies to provide a detailed design for a smartphone-smartwatch dyad for ambulatory AF monitoring. In this paper, we report on the system’s usability and opportunities to increase the acceptability of mHealth solutions among older patients with cognitive impairment. Trial Registration ClinicalTrials.gov NCT03761394; https://www.clinicaltrials.gov/ct2/show/NCT03761394 International Registered Report Identifier (IRRID) RR2-10.1016/j.cvdhj.2021.07.002

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“…Digital health initiatives, and specifically Mobile Health (mHealth) technology allow real-time feedback from patients on a larger scale and will eventually change the way we follow-up patients and measure outcomes. 15 , 27 , 65 , 66 Current mobile devices have built-in sensors (ie, accelerometer, gyroscope, and magnetometer) that can passively store tremendous amount of data for further processing to obtain relevant clinical information. 15 , 64 Despite over 350,000 health/fitness/medical apps currently available, 1 most of them work in isolation making it impossible to integrate and analyze data across different systems which has prevented the ability to scale their potential in research and clinical practice.…”

Smartwatch Technology's Diagnostic Use in Atrial Fibrillation Detection – A Literature Review

“…The disparity in lifestyle and technological intuition between the young and old results in a steep learning curve and poor user adherence in older adults. Pulsewatch is a novel smartwach program which provides continuous monitoring through the same PPG detection of the smartwatch, and the smartphone app serves as a data transfer hub between the watch and cloud [42]. Pulsewatch increases user accessibility in smartwatch technology with a streamlined user interface, in which the smartwatch face includes the time, heart rate, normal/abnormal rhythm, and a corresponding colour whether the rhythm is normal or abnormal, making AF detection easy to understand and recognize in older adults with cognitive impairment [42].…”

“…Pulsewatch is a novel smartwach program which provides continuous monitoring through the same PPG detection of the smartwatch, and the smartphone app serves as a data transfer hub between the watch and cloud [42]. Pulsewatch increases user accessibility in smartwatch technology with a streamlined user interface, in which the smartwatch face includes the time, heart rate, normal/abnormal rhythm, and a corresponding colour whether the rhythm is normal or abnormal, making AF detection easy to understand and recognize in older adults with cognitive impairment [42]. Monitoring occurs every 10 minutes for about 1.5 minutes, is processed in near real time (<1s), with a corresponding result, and is uploaded to the phone's local storage and cloud through the dyad; if abnormal rhythm is detected, the watch notifies the patient to hold still for around 1 minute to confirm the result (Figure 1) [42].…”

“…Pulsewatch increases user accessibility in smartwatch technology with a streamlined user interface, in which the smartwatch face includes the time, heart rate, normal/abnormal rhythm, and a corresponding colour whether the rhythm is normal or abnormal, making AF detection easy to understand and recognize in older adults with cognitive impairment [42]. Monitoring occurs every 10 minutes for about 1.5 minutes, is processed in near real time (<1s), with a corresponding result, and is uploaded to the phone's local storage and cloud through the dyad; if abnormal rhythm is detected, the watch notifies the patient to hold still for around 1 minute to confirm the result (Figure 1) [42]. Pulsewatch swaps the busy and potentially confusing user interface of most smartwatches, with a simple and easy to understand format while simultaneously using the same smartwatch technology, without the need for any added devices.…”

“…39% found the system to be highly usable, 64% strongly agreed or agreed the watch app was easy to use and 52% in response to the phone app. Overall over half enjoyed their experience using the system, while only 13% found the system stressful to use [42]. In an analysis on the Pulsewatch study done by Ding et al, 90 patients with assistive devices (ie.…”