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Original research
Evaluating patient attitudes and barriers towards smart technology for cardiac monitoring: results from a prospective multicentre study
  1. Anoop N Koshy1,2,
  2. Jefferson Ko1,2,
  3. Jithin K Sajeev1,
  4. Kevin Rajakariar1,
  5. Louise Roberts1,
  6. Jennifer Cooke1,
  7. Andrew W Teh1,2
  1. 1 Department of Cardiology, Monash University, Eastern Health Clinical School, Melbourne, Victoria, Australia
  2. 2 Department of Cardiology, Austin Health, University of Melbourne Clinical School, Melbourne, Victoria, Australia
  1. Correspondence to Associate Professor Andrew W Teh; andrew.teh{at}


Objectives Remote assessment of heart rate and rhythm using smart technology (ST) holds promise in screening and monitoring of atrial fibrillation (AF). However, patient engagement is paramount to the success of ST interventions.

Methods We assessed the attitudes and potential barriers towards ST for arrhythmia monitoring in an elderly, multimorbidity cohort. Consecutive inpatients were recruited across three hospitals and administered a standardised survey regarding attitudes towards ST for arrhythmia detection.

Results Of 363 participants (median age 68 years (IQR: 55–80 years), mean CHA2DS2VASC score 3±2), 68.9% were interested in ST for cardiac monitoring. Those with underlying AF (n=112) and younger (<65 years) patients were more likely to be interested in using ST for cardiac monitoring (p for both <0.001). Complexity (71.1%) of ST was identified as a major barrier to its adoption, particularly in older participants (p=0.02). While only 52% of participants trusted the accuracy of ST, over 90% would seek medical attention based on aberrant readings.

Conclusion We report a high level of interest among an older, high-risk patient cohort in using ST for cardiac monitoring. Despite a level of distrust in these devices, abnormal readings would still prompt the overwhelming majority of patients to seek medical attention. This highlights a need for physicians to validate the accuracy and clinical effectiveness of ST-derived physiological measurements, an area which remains unclear due to the paucity of trials.

Trial registration number ACTRN: 12616991374459.

  • atrial fibrillation
  • patient attitudes
  • mobile health
  • smartphone
  • survey
  • smart watch

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  • ANK and JK contributed equally.

  • Poster presentation Presented at Annual Scientific Sessions of The American College of Cardiology, New Orleans 2019

  • Contributors ANK, JK, JKS, JC, LR and AWT planned the study. These authors were involved in conceiving the study, undertaking ethics approvals and collating the questions for the survey and data to be collected. KR and JK conducted the survey and assisted in the manuscript writing and collation of patient baseline data and survey. JK also collated the figures and performed statistical analysis on the data. ANK is the guarantor responsible for the overall content.

  • Funding This work was supported by the Eastern Health Foundation Research Grant (EHFRG2017_029).

  • Competing interests ANK is a recipient of the National Health and Medical Research Council of Australia/National Heart Foundation Post-Graduate Scholarship and Royal Australasian College of Physicians Blackburn Scholarship. JKS is the recipient of an Australian Government Research Training Program Scholarship. AWT is a recipient of the Early Career Fellowship from the National Health and Medical Research Council of Australia.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.