Consumer wearable devices for evaluation of heart rate control using digoxin versus beta-blockers: the RATE-AF randomized trial.
Simrat K GillAndrey BarskyXin GuanKarina V BuntingAndreas KarwathOtilia TicaMary StanburySandra HaynesAmos A FolarinRichard James Butler DobsonJulia KurpsFolkert W AsselbergsDiederick E GrobbeeAlan John CammMarinus J C EijkemansGeorgios V GkoutosDipak Kotechanull nullnull nullnull nullPublished in: Nature medicine (2024)
Consumer-grade wearable technology has the potential to support clinical research and patient management. Here, we report results from the RATE-AF trial wearables study, which was designed to compare heart rate in older, multimorbid patients with permanent atrial fibrillation and heart failure who were randomized to treatment with either digoxin or beta-blockers. Heart rate (n = 143,379,796) and physical activity (n = 23,704,307) intervals were obtained from 53 participants (mean age 75.6 years (s.d. 8.4), 40% women) using a wrist-worn wearable linked to a smartphone for 20 weeks. Heart rates in participants treated with digoxin versus beta-blockers were not significantly different (regression coefficient 1.22 (95% confidence interval (CI) -2.82 to 5.27; P = 0.55); adjusted 0.66 (95% CI -3.45 to 4.77; P = 0.75)). No difference in heart rate was observed between the two groups of patients after accounting for physical activity (P = 0.74) or patients with high activity levels (≥30,000 steps per week; P = 0.97). Using a convolutional neural network designed to account for missing data, we found that wearable device data could predict New York Heart Association functional class 5 months after baseline assessment similarly to standard clinical measures of electrocardiographic heart rate and 6-minute walk test (F1 score 0.56 (95% CI 0.41 to 0.70) versus 0.55 (95% CI 0.41 to 0.68); P = 0.88 for comparison). The results of this study indicate that digoxin and beta-blockers have equivalent effects on heart rate in atrial fibrillation at rest and on exertion, and suggest that dynamic monitoring of individuals with arrhythmia using wearable technology could be an alternative to in-person assessment. ClinicalTrials.gov identifier: NCT02391337 .
Keyphrases
- heart rate
- atrial fibrillation
- heart failure
- heart rate variability
- physical activity
- blood pressure
- catheter ablation
- left atrial
- angiotensin converting enzyme
- oral anticoagulants
- convolutional neural network
- direct oral anticoagulants
- left atrial appendage
- end stage renal disease
- ejection fraction
- phase iii
- left ventricular
- newly diagnosed
- coronary artery disease
- electronic health record
- magnetic resonance
- study protocol
- clinical trial
- chronic kidney disease
- deep learning
- randomized controlled trial
- health information
- insulin resistance
- polycystic ovary syndrome
- placebo controlled
- climate change
- acute coronary syndrome
- magnetic resonance imaging
- artificial intelligence
- peritoneal dialysis
- pregnant women
- adipose tissue
- machine learning
- patient reported outcomes
- mitral valve