Insights & trends
Wearable devices are catching health issues earlier, often before patients notice any symptoms. But they also create a dilemma for clinicians: deciding which follow-up tests are necessary and whether these devices truly provide meaningful monitoring for patients.
In this case, a patient noticed an irregular rhythm on his smartwatch, prompting questions for the practitioner about the next steps for testing, monitoring, and the utility of wearable devices.
How would you proceed with testing, and do you recommend wearable health devices to your patients? Log in or sign up to share your approach and see the consensus.
Post:
A 74-year-old active male wears an Apple Watch, and he noticed it said he had atrial fibrillation. He looks back, and in the last several months, he has slowed down a little, but thought it was normal for his age. He has no palpitations or chest pains, or dizziness.
He has a history of hypertension, hyperlipidemia, and well-controlled type 2 diabetes. You do an EKG and it is normal, with a pulse of 68 regular. He asks what you advise, and you wisely arrange a cardiology appointment.
Questions for consult
1. What testing are you anticipating he will undergo?
2. Should you start him on a DOAC now or wait for his cardiology appointment, which is in 2 months? Should you ask the cardiologist to squeeze him in?
3. Will you suggest other patients of yours in the older age brackets to consider changing their wrist watches to a wearable rhythm detection-capable device as time goes on? Or do you think that will flood your office with calls?
Comments
Key takeaways about atrial fibrillation monitoring with wearables:
- Testing is cautious but thorough
Clinicians recommend echocardiograms, EKGs, and ambulatory/event monitors (Holter, patch, 14–30 day) to check for AF and structural heart disease, with additional labs or stress testing as needed. - Anticoagulation is usually deferred until AF is confirmed
Most would not start a DOAC without documented AF, though high-risk patients may prompt earlier cardiology evaluation. Immediate anticoagulation is less common due to bleeding concerns. - Wearables can be useful—but not for everyone
Smartwatches and other devices can help monitor established AF, but routine recommendation is limited due to false positives, patient anxiety, and increased calls. Patient tech literacy and cost should be considered.
Internal Medicine
"1. I would order a Holter monitor and a possible echo.
2. I would not start him on DOAC until there is confirmation of a fib. If he were in AFib, and if he started anticoagulation, I would call cardio to get him in sooner.
3. I would not suggest that other patients wear this. I think this would definitely lead to a lot of anxiety for patients and a lot of excessive phone calls and requests for immediate appointments."
Cardiology
"1. I anticipate he would need an echo, EKG, and routine labs to start. Additionally, he’ll also likely need testing to rule out cardiac ischemia, such as stress testing or a cardiac CT.
2. Start DOAC immediately and consider rhythm monitor x 14 days.
3. I would encourage patients to do what feels right for them, but would recommend a smart watch."
Cardiology
"1. Echocardiogram, EKG, thyroid function studies, and cardiac monitor (ideally a 30-day event monitor or MCOT for as much data as possible). Consider a stress test.
2. No, do not start a DOAC without clearly documented tracings confirming AF (wearable devices can have false-positive AF episodes).
3. Wearable devices can be helpful, but are expensive and require an understanding of technology. They often can have false-positive AFib detections, resulting in frequent phone calls to the office. Wearable devices are best suited for patients with established AFib for long-term monitoring, especially if anticoagulation is to be discontinued after ablation."
Cardiology
"1. I anticipate ambulatory monitoring (Holter or patch) and possibly an echocardiogram to evaluate for structural heart disease and paroxysmal AF.
2. I’d hold off on anticoagulation until AF is confirmed, but would ask cardiology if he can be seen sooner, given his risk factors.
3. I’d support selective use of wearables in older patients but caution widespread adoption to avoid unnecessary visits from false positives."
Internal Medicine
"1. I would order an event monitor and 2D echo.
2. Would not start DOAC without proper Dx. Would try and arrange for him to be seen earlier by Cardiology.
3. Yes, I would, but keep in mind the patient’s literacy level and if he/ she is able to afford a wearable rhythm detection device."
How would you approach follow-up testing and monitoring for a patient flagged by a wearable device? Read the full post on Healthcasts to see other practitioner perspectives and share your experience.
