Key result
Smartphone ECG wearables detect atrial fibrillation with ~95% sensitivity and specificity.
Why the study?
Conventional short-term monitoring often fails to detect AF because it is frequently paroxysmal and asymptomatic. While wearable technologies are promising tools for AF screening, their diagnostic performance requires comprehensive evaluation.
Do wearable and smartphone-based ECG and PPG technologies accurately detect atrial fibrillation compared to conventional electrocardiographic reference standards in adults?
Meta-Analysis (n=33,374)
Yes
Do wearable and smartphone-based ECG and PPG technologies accurately detect atrial fibrillation compared to conventional electrocardiographic reference standards in adults?
Wearable and smartphone-based ECG and PPG technologies demonstrate high sensitivity and specificity for atrial fibrillation detection across 51 studies, supporting their utility as scalable screening tools.
Supports smartphone ECG adoption for AF screening; confirms high accuracy across 51 studies and 33,374 participants.
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major cause of ischemic stroke. Because AF is frequently paroxysmal and asymptomatic, conventional short-term monitoring often fails to detect it. Wearable technologies have emerged as promising tools for AF screening, but their diagnostic performance requires comprehensive evaluation. We conducted a systematic review and diagnostic test accuracy meta-analysis following PRISMA-DTA guidelines. PubMed, Embase, and the Cochrane Library were searched from inception to 25 February 2026 for prospective and retrospective studies using electrocardiographic reference standards. Bivariate random-effects and Bayesian hierarchical models were used to pool diagnostic accuracy estimates. Fifty-one studies involving 33,374 participants from 15 countries were included. PPG-based smartwatches demonstrated the highest sensitivity (96.3%) with specificity of 93.6%. ECG-based smartwatches achieved sensitivity of 89.0% and specificity of 92.8% (DOR 103.9). Smartphone-based ECG devices showed the strongest overall diagnostic performance, with sensitivity of 94.5%, specificity of 95.8%, DOR of 396.4, LR+ of 22.6, and LR− of 0.057. Smartphone-based PPG applications achieved sensitivity of 92.0% and specificity of 91.9%. Apple Watch demonstrated sensitivity of 94.1% and specificity of 94.6%. Meta-regression revealed no statistically significant differences in diagnostic accuracy between device categories despite slightly higher point estimates for PPG-based smartwatches. No significant publication bias was detected (Deeks' test, p=0.18). Wearable devices demonstrate excellent diagnostic accuracy for AF detection, particularly smartphone-based ECG applications. These technologies support scalable AF screening and monitoring, although heterogeneity in study populations and diagnostic thresholds should be considered when applying these findings to routine clinical practice.
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Abbas et al. (2026) conducted a meta-analysis in Atrial fibrillation (n=33,374). Wearable and smartphone-based ECG and PPG technologies (smartwatches and smartphone applications) vs. Conventional electrocardiographic reference standard (12-lead ECG, Holter monitoring, or physician-adjudicated ECG) was evaluated on Diagnostic accuracy for atrial fibrillation detection (smartphone-based ECG devices) (DOR 396.39, 95% CI 180.14-872.27). Wearable devices showed high diagnostic accuracy for atrial fibrillation detection, with smartphone ECGs achieving 94.5% sensitivity, 95.8% specificity, and a DOR of 396.4.
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