ID: 4346888 DIAGNOSTIC YIELD AND HEALTHCARE UTILIZATION OF WEARABLE NOTIFICATIONS FOR ATRIAL FIBRILLATION

Background: Consumer wearables have FDA clearance to provide pre-diagnostic notifications for atrial fibrillation (AF).However, their post-market performance is not known.Objective: To use natural language processing and electronic health record data to study the diagnostic yield and healthcare utilization after AF notifications.Methods: We used a weak supervision-based labeling function to identify patients with AF notifications between 1/2019-8/2023.The model was trained on electronic health record data at a tertiary referral center (STARR, precision 84%, recall 81%, F1 83%) with preserved performance in the Veterans Health Administration (VHA) (93%, 64%, and 76%, accordingly).We evaluated diagnostic yield (AF diagnosis within 180 days) and used multivariate logistic regression to determine the association of comorbidities and care pathway with healthcare utilization.Results: There were 3462 STARR (age 61617, 44% female, 48% prior AF) and 11316 VHA patients (age 61615, 14% female, 79% white, 35% prior AF) with wearable notifications.Diagnostic yield was 14% and 25% in patients without AF history, compared to 87% and 90% in those with prior AF.In STARR, 4.1% and 9.2% of patients received inpatient and emergency room (ER) care within 5 days of notification, compared to 11.3% and 11.7% in the VHA.After multivariable adjustment, AF history was significantly associated with stress testing and echocardiograms; CHA2 DS2 -VASc did not have any significant associations.However, inpatient or ER care was significantly associated with almost all testing modalities (Figure). Conclusion:Here we demonstrate a novel approach for post-market evaluation of consumer wearables.We observed moderate diagnostic yield with high utilization of inpatient or ER care.Importantly, inpatient or ER care were stronger predictors of healthcare utilization than patient complexity.Standardized care pathways after wearable notification may reduce acute care visits and improve valuebased care.