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Enhanced Detection and Prompt Diagnosis of Atrial Fibrillation Using Apple Watch: A Randomized Controlled Trial
Nicole J van Steijn1, Isabel S Blommestijn1, Sebastiaan Blok2
1Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands; Cardiology Centers of the Netherlands, Utrecht, the Netherlands.
Journal of the American College of Cardiology
|January 22, 2026
Summary
Smartwatch screening significantly increased new onset atrial fibrillation (AF) detection in high-stroke-risk patients over six months. This remote monitoring approach proved more effective than standard care for identifying this common arrhythmia.
Area of Science:
- Cardiology
- Digital Health
- Preventive Medicine
Background:
- Atrial fibrillation (AF) is a leading cause of stroke, often undetected due to its asymptomatic and paroxysmal nature.
- Wearable technology offers a scalable, noninvasive method for screening cardiac arrhythmias like AF.
- Early detection of AF is crucial for implementing timely stroke prevention strategies.
Purpose of the Study:
- To evaluate the efficacy of remote smartwatch-based screening for detecting new-onset atrial fibrillation (AF).
- To compare the AF detection rate in patients at elevated stroke risk using smartwatch monitoring versus standard care.
- To assess the role of wearable technology in improving the diagnosis of AF in a high-risk population.
Main Methods:
- A prospective, multicenter randomized controlled trial involving 437 patients aged 65+ with elevated stroke risk (CHA₂DS₂-VASc ≥2 men, ≥3 women).
- Participants were randomized to either 6-month smartwatch monitoring (photoplethysmography and ECG) or standard care.
- New onset AF was confirmed via remote ECG review within 24 hours, defined as an episode lasting ≥30 seconds.
Main Results:
- New onset AF was detected in 9.6% of the smartwatch intervention group versus 2.3% in the standard care group (risk difference: 7.3%).
- The smartwatch group showed a significantly higher detection rate (P = 0.001) with a hazard ratio of 4.40.
- Several asymptomatic AF episodes were identified exclusively in the smartwatch group, highlighting its utility in detecting silent arrhythmias.
Conclusions:
- Six-month smartwatch-based screening significantly enhances the detection of new-onset atrial fibrillation in high-risk patients compared to standard care.
- Remote monitoring with smartwatches is an effective strategy for improving AF diagnosis and potentially reducing stroke risk in vulnerable populations.
- The EQUAL trial (NCT05686330) provides robust evidence for the clinical utility of wearable devices in cardiovascular screening.
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