Feasibility and diagnostic yield of a photoplethysmography-based arrhythmia screening and integrated management pathway in a chronic obstructive pulmonary disease outpatient clinic

Background and Aims Guidelines recommend opportunistic atrial fibrillation (AF) screening in high-risk populations, including chronic obstructive pulmonary disease (COPD) patients. This cohort study aimed to evaluate the feasibility and yield of a photoplethysmography (PPG) -based mHealth pathway for AF detection in a COPD outpatient clinic. Methods COPD patients at Maastricht University Medical Centre+ were invited to participate in a 14-day PPG -based AF screening embedded within the COPD care pathway using their smartphone. Results Out of 155 invited moderate-to-severe COPD patients, 99 (mean age 66±9 years, 54% female) participated in the AF screening. Adherence (101% [82%-123%]) and patient satisfaction (SUS 80.0 [IQR 55.0–92.5]) were high. The PPG-based pathway detected 8/99 (8,1%) AF cases (6 new, 2 known AF). Additional cardiac work-up of the 6 new cases revealed ECG confirmed AF in 2 (2.0%) patients and frequent premature beats in 3 patients. PPG analysis showed additional arrhythmias in 95/99 patients (isolated premature beats) and 31/99 patients (frequent premature beats), of which 8 (8.0%) patients necessitated additional cardiac analysis. Overall diagnostic yield of PPG-based AF screening was thus 8%, yield of ECG-confirmed new AF was 2% and in 10% of the patients additional arrhythmias were detected. Of the 99 patients, 12/99 (12%) patients needed referral to cardiac work-up. Conclusion 14-day opportunistic PPG-based, mHealth-supported AF screening is feasible in COPD outpatient care and results in the detection of new AF cases and premature beats. This novel digital approach offers a practical guidance for implementing recommended AF screening and management in COPD patients.