The use of a photoplethysmographyderiving smartphone app to screen for atrial fibrillation in primary stroke prevention during the covid pandemic

Background and Aims: Atrial fibrillation (AF) is the most common cardiac arrhythmia leading to a five-fold increased risk of stroke. During the COVID pandemic, most face-to-face consultations were cancelled which might lead to a significant amount of undetected AF patients. The aim of this pilot study was to assess the use of a photoplethysmography (PPG)-deriving smartphone app for early detection of AF and initiation of appropriate treatment to avoid AF-related complications such as stroke. Methods: Participants were instructed to perform heart rhythm measurements twice daily and when experiencing symptoms for 7 days using a PPG-deriving smartphone application. Results: A total of 201 eligible patients participated in the study with a mean age of 54 years, ranging from 40 to 84 years. In total, 55% of the population was male, and the AF prevalence was 5.47% (male n=6;age 61.7±5.3). All patients with possible AF based on the PPG measurements were confirmed on 24h Holter ECG. There were 3 patients without previously diagnosed AF. Five patients (45%) suffered from heart failure, 9 (82%) were known with hypertension and 7 (64%) were on anticoagulation therapy. One patient with AF had already a stroke. The CHA2DS2-VASc score was increased in participants with AF (score≥2). Conclusions: PPG-deriving technologies enable remote AF detection and may contribute to timely initiation of appropriate treatments to avoid complications such as AF-related strokes. One of the major advantages of this approach is the fact that physicians are able to remotely screen and follow-up patients at risk without the need for face-toface contacts.