Cardiovascular outcomes of wearable device-detected atrial fibrillation after major non-cardiac surgery: a prospective cohort study

Background Wearable devices enable resource-efficient continuous rhythm monitoring after major non-cardiac surgery. The prognostic relevance of wearable device–detected poAF, however, has not been well characterized. Purpose To assess the incidence of wearable device–detected poAF and its association with adverse cardiovascular outcomes within 90 days after surgery. Methods Consecutive patients with cardiovascular risk factors undergoing major non-cardiac surgery were prospectively included. All patients wore a wearable device for ≥48 hours postoperatively. Wearable device–detected poAF was defined as an episode lasting ≥60 seconds. The primary outcome was an ordinal composite of atrial fibrillation (AF) requiring treatment, stroke or transient ischemic attack (TIA), and cardiovascular death between postoperative day 2 and 90, analysed using partial proportional-odds ordinal logistic regression with adjustment for prespecified confounders. Secondary outcomes included all-cause mortality and the individual components of the primary endpoint. Results Among 467 eligible patients (median age 72 years [IQR 64–78]; 25% women), 108 (23.1%) developed poAF. The primary outcome occurred in 11.1% of patients with poAF versus 2.8% in patients without poAF (p=0.001), including cardiovascular death in 4.6% versus 0.8% (p=0.025), stroke/TIA in 5.6% versus 1.1% (p=0.016), and AF requiring treatment in 1.9% versus 1.4% (p=1.000). After multivariable adjustment, poAF remained independently associated with the primary outcome (cumulative odds ratio 3.61, 95% CI 1.38–9.43). At 90 days, all-cause mortality occurred in 9.3% of patients with poAF versus 2.2% without (p=0.002). New prescriptions of oral anticoagulation, beta-blockers, or antiarrhythmic therapy at discharge were low and did not differ significantly between groups (Figure 2). Conclusions Wearable device–detected poAF was common and independently associated with a markedly increased risk of adverse cardiovascular outcomes within 90 days after major non-cardiac surgery, offering a resource-efficient approach to detect prognostically relevant poAF after major non-cardiac surgery.