Physician Responses to Apple Watch-Detected Irregular Rhythm Alerts: A Case-Based Survey

Background While the US Food and Drug Administration (FDA) has cleared smart watch software for detecting atrial fibrillation (AF), there is lack of guidance on management by physicians. Methods We conducted a case-based survey of physicians in primary care, emergency medicine, and cardiology at Yale and University of California San Francisco from September to December 2021. Cases described asymptomatic patients receiving Apple Watch AF alerts; cases varied in sex, race, medical (diabetes and hypertension) history, and notification frequency. Physicians were asked to select from among prespecified diagnostic testing, referral, and treatment options. Results We emailed 636 physicians, of whom 95 (14.9%) filled out the survey, including 39 primary care, 25 emergency medicine, and 31 cardiology physicians. Among a total of 192 cases (16 unique scenarios), physicians selected at least one diagnostic test in 191 (99.5%) cases and medications in 48 (25.0%). Rates of patient referral (14%, 30%, and 16%, respectively; P=.048), rhythm monitoring (84%, 46%, and 94%, respectively; P<.001), measurement of BNP (8%, 20%, and 2%; P=.003), and use of antiarrhythmics (16%, 4%, and 23%; P=.023) varied among primary care, emergency medicine, and cardiology, respectively. Management was largely consistent across case characteristics (race, sex, medical history, and alert frequency). Conclusion In hypothetical cases of patients presenting without clinical symptoms, physicians opted for further diagnostic testing and often to medical intervention based on Apple Watch irregular rhythm notifications. There was also considerable variation across physician specialties, suggesting a need for uniform clinical practice guidelines.