Evaluation of Heart Rate Trackers in Patients With Atrial Fibrillation

Leader, Nathan; Dorian, Paul; Lam, Juan F.; Lee, C.; Woo, Anna; Chow, C.

doi:10.1016/j.cjca.2018.07.174

Cited by 7 publications

(5 citation statements)

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“…Although previous research has questioned the use of PPG sensors in darker skin, a recently published study showed no statistically significant differences in wearable heart rate measurement accuracy across skin tones [ 43 ]. However, a number of studies have shown that PPG sensors are less reliable at higher heart rates and during exercise [ 44 , 45 ]. As some studies in this review did not report the average heart rate of participants, it may add a level of bias to the results.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis

et al. 2021

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Background Significant morbidity, mortality, and financial burden are associated with cardiac rhythm abnormalities. Conventional investigative tools are often unsuccessful in detecting cardiac arrhythmias because of their episodic nature. Smartwatches have gained popularity in recent years as a health tool for the detection of cardiac rhythms. Objective This study aims to systematically review and meta-analyze the diagnostic accuracy of smartwatches in the detection of cardiac arrhythmias. Methods A systematic literature search of the Embase, MEDLINE, and Cochrane Library databases was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies reporting the use of a smartwatch for the detection of cardiac arrhythmia. Summary estimates of sensitivity, specificity, and area under the curve were attempted using a bivariate model for the diagnostic meta-analysis. Studies were examined for quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Results A total of 18 studies examining atrial fibrillation detection, bradyarrhythmias and tachyarrhythmias, and premature contractions were analyzed, measuring diagnostic accuracy in 424,371 subjects in total. The signals analyzed by smartwatches were based on photoplethysmography. The overall sensitivity, specificity, and accuracy of smartwatches for detecting cardiac arrhythmias were 100% (95% CI 0.99-1.00), 95% (95% CI 0.93-0.97), and 97% (95% CI 0.96-0.99), respectively. The pooled positive predictive value and negative predictive value for detecting cardiac arrhythmias were 85% (95% CI 0.79-0.90) and 100% (95% CI 1.0-1.0), respectively. Conclusions This review demonstrates the evolving field of digital disease detection. The current diagnostic accuracy of smartwatch technology for the detection of cardiac arrhythmias is high. Although the innovative drive of digital devices in health care will continue to gain momentum toward screening, the process of accurate evidence accrual and regulatory standards ready to accept their introduction is strongly needed. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020213237; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=213237.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis

et al. 2021

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“…Investigations have found earbud-based heart rate to be acceptable during resistance training (MAPE = 6.24%) [ 9 ], graded exercise testing on a treadmill (bias = -0.2%, R 2 = 0.98) [ 52 ], and during treadmill exercise and high intensity training exercises (bias = 0.8 bpm, MAPE = 2.48%, r C = 0.943; bias = -3.6 bpm, MAPE = 3.53%, r C = 0.861 respectively) [ 8 ]. When utilized in patients with cardiac diseases, these devices tended to have less agreement when heart rate was above 100 bpm and in participants with atrial fibrillation (average difference to true heart rate = 20.3 bpm, r 2 = 0.434) [ 53 ]. One investigation utilizing cycle graded exercise testing found that heart validity decreased in earbud devices as the intensity of this exercise increased (MAPE at 50W = 6.4%, MAPE at 200W = 15.42%) [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Concurrent heart rate validity of wearable technology devices during trail running

Navalta¹,

Montes²,

Bodell³

et al. 2020

PLoS ONE

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Validation of heart rate responses in wearable technology devices is generally composed of laboratory-based protocols that are steady state in nature and as a result, high accuracy measures are returned. However, there is a need to understand device validity in applied settings that include varied intensities of exercise. The purpose was to determine concurrent heart rate validity during trail running. Twenty-one healthy participants volunteered (female n = 10, [mean (SD)]: age = 31 [ 11 ] years, height = 173.0 [ 7 ] cm, mass = 75.6 [ 13 ] kg). Participants were outfitted with wearable technology devices (Garmin Fenix 5 wristwatch, Jabra Elite Sport earbuds, Motiv ring, Scosche Rhythm+ forearm band, Suunto Spartan Sport watch with accompanying chest strap) and completed a self-paced 3.22 km trail run while concurrently wearing a criterion heart rate strap (Polar H7 heart rate monitor). The trail runs were out-and-back with the first 1.61 km in an uphill direction, and the 1.61 return being downhill in nature. Validity was determined through three methods: Mean Absolute Percent Error (MAPE), Bland-Altman Limits of Agreement (LOA), and Lin’s Concordance Coefficient (r C ). Validity measures overall are as follows: Garmin Fenix 5 (MAPE = 13%, LOA = -32 to 162, r C = 0.32), Jabra Elite Sport (MAPE = 23%, LOA = -464 to 503, r C = 0.38), Motiv ring (MAPE = 16%, LOA = -52 to 96, r C = 0.29), Scosche Rhythm+ (MAPE = 6%, LOA = -114 to 120, r C = 0.79), Suunto Spartan Sport (MAPE = 2%, LOA = -62 to 61, r C = 0.96). All photoplethysmography-based (PPG) devices displayed poor heart rate agreement during variable intensity trail running. Until technological advances occur in PPG-based devices allowing for acceptable agreement, heart rate in outdoor environments should be obtained using an ECG-based chest strap that can be connected to a wristwatch or other comparable receiver.

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“…On the other hand, graded exercise testing on a cycle ergometer resulted in heart validity that decreased as exercise intensity increased (MAPE at 50 W = 6.4%, MAPE at 200 W = 15.42%) [31]. Additionally, the Jabra Pulse earbud device tended to have less agreement compared to ECG when heart rate was above 100 bpm in patients with cardiac diseases and in participants with atrial fibrillation (r 2 = 0.434) [32]. Finally, the Jabra Elite Sport earbud device was determined to have poor agreement compared to a criterion chest strap during trail running at variable intensities of exercise (MAPE = 21.3%, rc = 0.384, ICC = 0.395) [21].…”

Section: Discussionmentioning

confidence: 99%

Assessing Heart Rate Using Consumer Technology Association Standards

et al. 2021

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It is difficult for developers, researchers, and consumers to compare results among emerging wearable technology without using a uniform set of standards. This study evaluated the accuracy of commercially available wearable technology heart rate (HR) monitors using the Consumer Technology Association (CTA) standards. Participants (N = 23) simultaneously wore a Polar chest strap (criterion measure), Jabra Elite earbuds, Scosche Rhythm 24 armband, Apple Watch 4, and Garmin Forerunner 735 XT during sitting, activities of daily living, walking, jogging, running, and cycling, totaling 57 min of monitored activity. The Apple Watch mean bias was within ±1 bpm, and mean absolute percent error (MAPE) was <3% in all six conditions. Garmin underestimated HR in all conditions, except cycling and MAPE was >10% during sedentary, lifestyle, walk-jog, and running. The Jabra mean bias was within ±5 bpm for each condition, and MAPE exceeded 10% for walk-jog. The Scosche mean bias was within ±1 bpm and MAPE was <5% for all conditions. In conclusion, only the Apple Watch Series 4 and the Scosche Rhythm 24 displayed acceptable agreement across all conditions. By employing CTA standards, future developers, researchers, and consumers will be able to make true comparisons of accuracy among wearable devices.

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Evaluation of Heart Rate Trackers in Patients With Atrial Fibrillation

Cited by 7 publications

References 0 publications

Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis

Diagnostic Accuracy of Smartwatches for the Detection of Cardiac Arrhythmia: Systematic Review and Meta-analysis

Concurrent heart rate validity of wearable technology devices during trail running

Assessing Heart Rate Using Consumer Technology Association Standards

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