Fully Automated Photoplethysmography-Based Wearable Atrial Fibrillation Screening in a Hospital Setting

<b>Background/Objectives</b>: Atrial fibrillation (AF) remains a major risk factor for stroke. It is often asymptomatic and paroxysmal, making it difficult to detect with conventional electrocardiography (ECG). While photoplethysmography (PPG)-based devices like smartwatches have demonstrated efficacy in detecting AF, they are rarely integrated into hospital infrastructure. The study aimed to establish a seamless system for real-time AF screening in hospitalized high-risk patients using a wrist-worn PPG device integrated into a hospital's data infrastructure. <b>Methods</b>: In this investigator-initiated prospective clinical trial conducted at the University Hospital Basel, patients with a CHA₂DS₂-VASc score ≥ 2 and no history of AF received a wristband equipped with a PPG sensor for continuous monitoring during their hospital stay. The PPG data were automatically transmitted, analyzed, stored, and visualized. Upon detection of an absolute arrhythmia (AA) in the PPG signal, a Holter ECG was administered. <b>Results</b>: The analysis encompassed 346 patients (mean age 72 ± 10 years, 175 females (50.6%), mean CHA₂DS₂-VASc score 3.5 ± 1.3)). The mean monitoring duration was 4.3 ± 4.4 days. AA in the PPG signal was detected in twelve patients (3.5%, CI: 1.5-5.4%), with most cases identified within 24 h (<i>p</i> = 0.004). There was a 1.3 times higher AA burden during the nighttime compared to daytime (<i>p</i> = 0.03). Compliance was high (304/346, 87.9%). No instances of AF were confirmed in the nine patients undergoing Holter ECG. <b>Conclusions</b>: This study successfully pioneered an automated infrastructure for AF screening in hospitalized patients through the use of wrist-worn PPG devices. This implementation allowed for real-time data visualization and intervention in the form of a Holter ECG. The high compliance and early AA detection achieved in this study underscore the potential and relevance of this novel infrastructure in clinical practice.