Wyatt KD et al.: Clinical evaluation and diagnostic yield following evaluation of abnormal pulse detected using Apple Watch. J Am Med Inform Assoc (2020) 27(9):1359-1363.
doi: 10.1093/jamia/ocaa137
In einem Zeitraum von 4 Monaten (Dez. 2018 bis März 2019) wurden von den 767.338 Patienten aller Mayo-Klinik-Standorte in den USA mittels automatisierter Textanalyse insgesamt 598 Patienten identifiziert, in deren E-Akte der Begriff „Apple Watch“ auftauchte. 64 verweigerten den Zugriff auf ihre Akte, von den verbleibenden 534 wurden 270 manuell aussortiert, weil der Begriff „Apple Watch“ nicht im Zusammenhang mit Pulsabnormitäten stand. Übrig blieben 264 Patienten, von denen 41 (15.5 %) explizit eine „Abnormer Puls“-Warnung erhalten hatten. Bei 6 von diesen 41 Patienten (15 %) wurde eine klinisch bedeutsame kardiovaskuläre Diagnose gestellt.
Objective: The study sought to characterize the evaluation of patients who present following detection of an ab- normal pulse using Apple Watch.
Materials and Methods: We conducted a retrospective review of patients evaluated for abnormal pulse detected using Apple Watch over a 4-month period.
Results: Among 264 included patients, clinical documentation for 41 (15.5%) explicitly noted an abnormal pulse alert. Preexisting atrial fibrillation was noted in 58 (22.0%). Most commonly performed testing included 12-lead echocardiography (n = 158; 59.8%), Holter monitor (n = 77; 29.2%), and chest x-ray (n = 64; 24.2%). A clinically actionable cardiovascular diagnosis of interest was established in only 30 (11.4%) patients, including 6 of 41 (15%) patients who received an explicit alert.
Discussion: False positive screening results may lead to overutilization of healthcare resources.
Conclusions: The Food and Drug Administration and Apple should consider the unintended consequences of widespread screening for asymptomatic (“silent”) atrial fibrillation and use of the Apple Watch abnormal pulse detection functionality by populations in whom the device has not been adequately studied.