Detection of atrial fibrillation using mobile health applications based on photoplethysmography in high-risk populations.

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased stroke risk which can be reduced by 65% with anticoagulation therapy. Detection of AF is hampered by its paroxysmal nature and frequent asymptomatic occurrence. Screening has been suggested to increase AF detection rates and potentially prevent stroke. Targeting screening to the CHA2DS2-VASc risk score can identify individuals who are more likely both to display AF upon screening and simultaneously to benefit from treatment. The effectiveness of screening is strongly influenced by its duration because of the paroxysmal nature of AF. Therefor screening should be performed by repetitive time-point measurements or continuous monitoring. Photoplethysmography (PPG) is a technique that exploits a smartphone camera to detect AF and potentially support a low-cost high-performance screening tool. This research project aims to (1) compare the effect of systematic screening with PPG in high-risk populations versus opportunistic screening (as current guideline directed practice) on the detection rate of asymptomatic AF in primary prevention, (2) to evaluate the effect of PPG based screening for AF on clinical outcomes, (3) to explore the utility of PPG traces to predict the future occurrence of AF and (4) identify hurdles for the implementation of PPG based mobile health applications. If successful, this project could impact guideline directed care on AF.